Institute for Research on Equity and Community Health, ChristianaCare Health Systems, Wilmington, Delaware.
Urban Health Collaborative, Drexel University, Philadelphia, Pennsylvania.
Am J Prev Med. 2022 Sep;63(3):362-370. doi: 10.1016/j.amepre.2022.02.004. Epub 2022 Mar 30.
Homelessness is associated with increased acute care utilization and poor healthcare outcomes. This study aims to compare hospital readmission rates among patients experiencing homelessness and patients who are not homeless and assess the impact of different clinical and demographic characteristics on acute care utilization among patients experiencing homelessness.
This was a retrospective study of patients encountered in 2018 and 2019 at ChristianaCare Health Systems. The analysis was done in August 2021. The prevalence of major chronic conditions among patients experiencing homelessness (n=1,329) and those not experiencing it (n=143,360) was evaluated. Patients experiencing homelessness were matched with nonhomeless patients using 1:1 propensity score matching. Time-to-event analysis approaches were used to analyze time-to-readmission and 30-day readmission rates.
The 30-day readmission rates were 42.8% among patients experiencing homelessness and 19.9% among matched patients not experiencing homelessness. The hazard of 30-day readmission among patients experiencing homelessness was 2.6 (95% CI=1.93, 3.53) times higher than that among the matched nonhomeless cohort. In patients experiencing homelessness, drug use disorder, major depressive disorder, chronic kidney disease, obesity, arthritis, HIV/AIDS, and epilepsy were associated with shortened time to readmission. Moreover, Black racial identity was associated with shortened time to readmission.
Patients experiencing homelessness had higher acute care utilization than those not experiencing homelessness. Black racial identity and several comorbidities were associated with increased acute care utilization among patients experiencing homelessness. Efforts to address upstream social determinants of health, destigmatization, and healthcare management accounting for the whole spectrum of clinical comorbidities might be important in promoting the health of people experiencing homelessness.
无家可归与急性护理利用率增加和医疗保健效果不佳有关。本研究旨在比较无家可归患者和非无家可归患者的住院再入院率，并评估不同临床和人口统计学特征对无家可归患者急性护理利用率的影响。
这是一项 2018 年和 2019 年在克里斯蒂安娜保健系统就诊的患者的回顾性研究。分析于 2021 年 8 月进行。评估了无家可归患者（n=1329）和非无家可归患者（n=143360）中主要慢性疾病的患病率。使用 1:1 倾向评分匹配对无家可归患者进行匹配。采用生存分析方法分析再入院时间和 30 天再入院率。
无家可归患者的 30 天再入院率为 42.8%，匹配的非无家可归患者为 19.9%。无家可归患者 30 天再入院的风险是匹配的非无家可归队列的 2.6 倍（95%CI=1.93，3.53）。在无家可归患者中，药物使用障碍、重度抑郁症、慢性肾脏病、肥胖症、关节炎、HIV/AIDS 和癫痫与再入院时间缩短有关。此外，黑人种族身份与再入院时间缩短有关。
无家可归患者的急性护理利用率高于非无家可归患者。黑人种族身份和几种合并症与无家可归患者的急性护理利用率增加有关。解决健康的社会决定因素、消除污名化以及考虑到整个临床合并症谱的医疗保健管理，可能对促进无家可归者的健康很重要。
