Department of Public Health, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
Health Services Research Development Center, University of Tsukuba, Tsukuba, Ibaraki, Japan.
J Gen Intern Med. 2020 Sep;35(9):2560-2568. doi: 10.1007/s11606-020-06029-0. Epub 2020 Jul 14.
As the U.S. homeless population grows, so has the challenge of providing effective care to homeless individuals. Understanding hospitals that achieve better outcomes after hospital discharge for homeless patients has important implications for making our health system more sustainable and equitable.
To determine whether homeless patients experience higher rates of readmissions and emergency department (ED) visits after hospital discharge than non-homeless patients, and whether the homeless patients exhibit lower rates of readmissions and ED visits after hospital discharge when they were admitted to hospitals experienced with the treatment of the homeless patients ("homeless-serving" hospitals-defined as hospitals in the top decile of the proportion of homeless patients).
A population-based longitudinal study, using the data including all hospital admissions and ED visits in FL, MA, MD, and NY in 2014.
Participants were 3,527,383 patients (median age [IQR]: 63 [49-77] years; 1,876,466 [53%] women; 134,755 [4%] homeless patients) discharged from 474 hospitals.
Risk-adjusted rates of 30-day all-cause readmissions and ED visits after hospital discharge.
After adjusting for potential confounders, homeless patients had higher rates of readmissions (adjusted rate, 27.3% vs. 17.5%; adjusted odds ratio [aOR], 1.93; 95% CI, 1.69-2.21; p < 0.001) and ED visits after hospital discharge (37.1% vs. 23.6%; aOR, 1.98; 95% CI, 1.74-2.25; p < 0.001) compared with non-homeless patients. Homeless patients treated at homeless-serving hospitals exhibited lower rates of readmissions (23.9% vs. 33.4%; p < 0.001) and ED visits (31.4% vs. 45.4%; p < 0.001) after hospital discharge than homeless patients treated at non-homeless-serving hospitals.
Homeless patients were more likely to be readmitted or return to ED within 30 days after hospital discharge, especially when they were treated at hospitals that treat a small proportion of homeless patients. These findings suggest that homeless patients may receive better discharge planning and care coordination when treated at hospitals experienced with caring for homeless people.
随着美国无家可归人口的增加，为无家可归者提供有效护理的挑战也越来越大。了解那些在为无家可归者提供治疗方面表现更好的医院对于使我们的医疗体系更具可持续性和公平性具有重要意义。
确定无家可归患者在出院后与非无家可归患者相比，是否有更高的再入院率和急诊部（ED）就诊率，以及当他们入住治疗无家可归患者经验丰富的医院（“服务于无家可归者”的医院——定义为无家可归患者比例最高的前十分之一的医院）时，无家可归患者出院后再入院率和 ED 就诊率是否较低。
一项基于人群的纵向研究，使用包括 2014 年佛罗里达州、马萨诸塞州、马里兰州和纽约所有住院和 ED 就诊的数据。
参与者为 3527383 名（中位数年龄[IQR]：63[49-77]岁；1876466[53%]为女性；134755[4%]为无家可归者）从 474 家医院出院的患者。
出院后 30 天内全因再入院和 ED 就诊的风险调整率。
在调整了潜在混杂因素后，无家可归患者的再入院率（调整后的比率，27.3% vs. 17.5%；调整后的比值比[aOR]，1.93；95%置信区间[CI]，1.69-2.21；p<0.001）和 ED 就诊率（37.1% vs. 23.6%；aOR，1.98；95%CI，1.74-2.25；p<0.001）均高于非无家可归患者。与非无家可归患者相比，在服务于无家可归者的医院接受治疗的无家可归患者，其出院后再入院率（23.9% vs. 33.4%；p<0.001）和 ED 就诊率（31.4% vs. 45.4%；p<0.001）较低。
与非无家可归患者相比，无家可归患者在出院后 30 天内再次入院或返回 ED 的可能性更高，尤其是当他们在治疗无家可归患者比例较小的医院接受治疗时。这些发现表明，当无家可归患者在有经验治疗无家可归者的医院接受治疗时，他们可能会得到更好的出院计划和护理协调。
