Association of Social Needs and Housing Status Among Urban Emergency Department Patients

Wormley, Kadia; Dickson, Drusia; Alter, Harrison J.; Njoku, Ndidi; Imani, Partow; Anderson, Eric G.

doi:10.5811/westjem.2022.8.55705

Cited by 3 publications

(2 citation statements)

References 43 publications

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“…To our knowledge, no universal method exists within EDs to identify patients experiencing housing insecurity and to systematically provide support for their needs. Screening for housing insecurity is uncommon among standard ED protocols, and housing status is rarely recorded in patient medical records . We believe that identifying housing instability, which often co-occurs with other structural inequalities, is the first step in delivering health care that truly addresses social determinants of health.…”

Section: Discussionmentioning

confidence: 99%

“…Screening for housing insecurity is uncommon among standard ED protocols, and housing status is rarely recorded in patient medical records. 19 , 34 We believe that identifying housing instability, which often co-occurs with other structural inequalities, 35 is the first step in delivering health care that truly addresses social determinants of health.…”

Section: Discussionmentioning

confidence: 99%

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Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Ball,

Sack,

Druffner

et al. 2024

JAMA Netw Open

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ImportanceUnstable housing and homelessness can exacerbate adverse health outcomes leading to increased risk of chronic disease, injury, and disability. However, emergency departments (EDs) have no universal method to identify those at risk of or currently experiencing homelessness.ObjectiveTo describe the extent of housing insecurity among patients who seek care in an urban ED, including chief concerns, demographics, and patterns of health care utilization.Design, Setting, and ParticipantsThis cross-sectional study included all adult patients presenting to the ED at Vanderbilt University Medical Center (VUMC), an urban tertiary care, level I trauma center in the Southeast US, from January 5 to May 16, 2023.Main Outcomes and MeasuresThe primary outcome was the proportion of ED visits at which patients screened positive for housing insecurity. Secondary outcomes included prevalence of insecurity by chief concerns, demographics, and patterns of health care utilization.ResultsOf all 23 795 VUMC ED visits with screenings for housing insecurity (12 465 visits among women [52%]; median age, 47 years [IQR, 32-48 years]), in 1185 (5%), patients screened positive for current homelessness or housing insecurity (660 unique patients); at 22 610 visits (95%), the screening result was negative. Of visits with positive results, the median age of patients was 46 years (IQR, 36-55 years) and 829 (70%) were among male patients. Suicide and intoxication were more common chief concerns among visits at which patients screened positive (132 [11%] and 118 [10%], respectively) than among those at which patients screened negative (220 [1%] and 335 [2%], respectively). Visits with positive results were more likely to be among patients who were uninsured (395 [33%] vs 2272 [10%]) and had multiple visits during the study period. A higher proportion of positive screening results occurred between 8 pm and 6 am. The social work team assessed patients at 919 visits (78%) with positive screening results.Conclusions and RelevanceIn this cross-sectional study of 23 795 ED visits, at 5% of visits, patients screened positive for housing insecurity and were more likely to present with a chief concern of suicide, to be uninsured, and to have multiple visits during the study period. This analysis provides a call for other institutions to introduce screening and create tailored care plans for patients experiencing housing insecurity to achieve equitable health care.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Ball,

Sack,

Druffner

et al. 2024

JAMA Netw Open

View full text Add to dashboard Cite

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Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon)

Dickson,

Ergun-Longmire,

Greydanus

et al. 2024

Disease-a-Month

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Emergency department use and geospatial variation in social determinants of health: a pilot study from South Carolina

DeMass,

Gupta,

Self

et al. 2023

BMC Public Health

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Background Health systems are increasingly addressing patients’ social determinants of health (SDoH)-related needs and investigating their effects on health resource use. SDoH needs vary geographically; however, little is known about how this geographic variation in SDoH needs impacts the relationship between SDoH needs and health resource use. Methods This study uses data from a SDoH survey administered to a pilot patient population in a single health system and the electronic medical records of the surveyed patients to determine if the impact of SDoH needs on emergency department use varies geospatially at the US Census block group level. A Bayesian zero-inflated negative binomial model was used to determine if emergency department visits after SDoH screening varied across block groups. Additionally, the relationships between the number of emergency department visits and the response to each SDoH screening question was assessed using Bayesian negative binomial hurdle models with spatially varying coefficients following a conditional autoregressive (CAR) model at the census block group level. Results Statistically important differences in emergency department visits after screening were found between block groups. Statistically important spatial variation was found in the association between patient responses to the questions concerning unhealthy home environments (e.g. mold, bugs/rodents, not enough air conditioning/heat) or domestic violence/abuse and the mean number of emergency department visits after the screen. Conclusions Notable spatial variation was found in the relationships between screening positive for unhealthy home environments or domestic violence/abuse and emergency department use. Despite the limitation of a relatively small sample size, sensitivity analyses suggest spatially varying relationships between other SDoH-related needs and emergency department use.

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Association of Social Needs and Housing Status Among Urban Emergency Department Patients

Cited by 3 publications

References 43 publications

Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED

Health equity in pediatrics: Current concepts for the care of children in the 21st century (Dis Mon)

Emergency department use and geospatial variation in social determinants of health: a pilot study from South Carolina

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