Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery

Titan, Ashley L.; Graham, Laura A.; Rosen, Amy K.; Itani, Kamal M.F.; Copeland, Laurel A.; Mull, Hillary J.; Burns, Edith; Richman, Joshua S.; Kertesz, Stefan G.; Wahl, Tyler S.; Morris, Melanie S.; Whittle, Jeff; Telford, Gordon L.; Wilson, Mark A.; Hawn, Mary T.

doi:10.1097/mlr.0000000000000915

Cited by 44 publications

(50 citation statements)

References 21 publications

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“…13 Another recent study of veterans discharged from the hospital after surgical procedures, which included 5068 homeless patients, found a 43% higher odds of readmission to the hospital associated with homelessness. 14 We observed a smaller absolute difference in the readmission rates between the homeless and housed groups compared with some of these prior studies. Although differences in the definition of homelessness, statistical methods, and smaller sample sizes of those studies make direct comparisons difficult, our findings are concordant in that they demonstrated a significantly higher readmission rate associated with homelessness.…”

Section: Discussioncontrasting

confidence: 54%

“…Prior studies suggest that homeless individuals may experience higher rates of readmission after an index hospitalization. [12][13][14] However, these studies have been limited by a relatively small sample size of patients J Gen Intern Med 35 (9):2576-83 experiencing homelessness or have only evaluated certain medical conditions or procedures.…”

Section: Introductionmentioning

confidence: 99%

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Association of Homelessness with Hospital Readmissions—an Analysis of Three Large States

et al. 2020

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BACKGROUND: Individuals experiencing homelessness have higher hospitalization and mortality rates compared with the housed. Whether they also experience higher readmission rates, and if readmissions vary by region or cause of hospitalization is unknown. OBJECTIVE: Evaluate the association of homelessness with readmission rates across multiple US states. DESIGN: Retrospective analysis of administrative claims PATIENTS: All inpatient hospitalizations in Florida, Massachusetts, and New York from January 2010 to October 2015 MAIN MEASURES: Thirty-and 90-day readmission rates KEY RESULTS: Out of a total of 23,103,125 index hospitalizations, 515,737 were for patients who were identified as homeless at the time of discharge. After adjusting for cause of index hospitalization, state, demographics, and clinical comorbidities, 30-day and 90-day readmission rates were higher for index hospitalizations in the homeless compared with those in the housed group. The difference in 30-day readmission rates between homeless and housed groups was the largest in Florida (30.4% vs. 19.3%; p < 0.001), followed by Massachusetts (23.5% vs. 15.2%; p < 0.001) and New York (15.7% vs. 13.4%; p < 0.001) (combined 17.3% vs. 14.0%; p < 0.001). Among the most common causes of hospitalization, 30-day readmission rates were 4.1 percentage points higher for the homeless group for mental illness, 4.9 percentage points higher for diseases of the circulatory system, and 2.4 percentage points higher for diseases of the digestive system. CONCLUSIONS: After adjusting for demographic and clinical characteristics, homelessness is associated with significantly higher 30-and 90-day readmission rates, with a significant variation across the three states.Interventions to reduce the burden of readmissions among individuals experiencing homelessness are urgently needed. Differences across states point to the potential of certain public policies to impact health outcomes for individuals experiencing homelessness.

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Section: Discussioncontrasting

confidence: 54%

Section: Introductionmentioning

confidence: 99%

Association of Homelessness with Hospital Readmissions—an Analysis of Three Large States

et al. 2020

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“…[9][10][11] As a result, outcomes after hospital discharge may be poor, and studies in the USA have shown that homeless inpatients are more likely to be readmitted than housed inpatients. [12][13][14][15] In response to concerns about poor discharge arrangements for homeless inpatients, the UK government set up the 'Homeless Hospital Discharge Fund', 16 which funded partnerships of National Health Service (NHS) and non-profit organisations to develop methods of supported discharge. These schemes operated between 2013 and 2016 and used a range of models.…”

Section: Introductionmentioning

confidence: 99%

Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

Lewer

Menezes

Cornes

et al. 2021

J Epidemiol Community Health

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BackgroundInpatients experiencing homelessness are often discharged to unstable accommodation or the street, which may increase the risk of readmission.MethodsWe conducted a cohort study of 2772 homeless patients discharged after an emergency admission at 78 hospitals across England between November 2013 and November 2016. For each individual, we selected a housed patient who lived in a socioeconomically deprived area, matched on age, sex, hospital, and year of discharge. Counts of emergency readmissions, planned readmissions, and Accident and Emergency (A&E) visits post-discharge were derived from national hospital databases, with a median of 2.8 years of follow-up. We estimated the cumulative incidence of readmission over 12 months, and used negative binomial regression to estimate rate ratios.ResultsAfter adjusting for health measured at the index admission, homeless patients had 2.49 (95% CI 2.29 to 2.70) times the rate of emergency readmission, 0.60 (95% CI 0.53 to 0.68) times the rate of planned readmission and 2.57 (95% CI 2.41 to 2.73) times the rate of A&E visits compared with housed patients. The 12-month risk of emergency readmission was higher for homeless patients (61%, 95% CI 59% to 64%) than housed patients (33%, 95% CI 30% to 36%); and the risk of planned readmission was lower for homeless patients (17%, 95% CI 14% to 19%) than for housed patients (30%, 95% CI 28% to 32%). While the risk of emergency readmission varied with the reason for admission for housed patients, for example being higher for admissions due to cancers than for those due to accidents, the risk was high across all causes for homeless patients.ConclusionsHospital patients experiencing homelessness have high rates of emergency readmission that are not explained by health. This highlights the need for discharge arrangements that address their health, housing and social care needs.

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“…11 Titan et al looked at surgeries that occurred within the Veterans Health Administration and found that patients without housing were more likely to be readmitted postoperatively as compared with those individuals who had housing. 12 Patients residing in vulnerable communities have a markedly increased risk for serious postoperative complications, which increased relative to social vulnerability in a linear fashion. 13 The impact of social vulnerability was more evident in Black/minority patients, with an increased risk of mortality among Black patients across several surgical procedures and consistently higher than White patients.…”

Section: Current Situationmentioning

confidence: 99%

Social Determinants of Health and Impact in Perioperative Space

Devin

Shaffer

2023

Clin Colon Rectal Surg

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The Centers for Disease Control and Prevention (CDC) defines the social determinants of health (SDOH) as “the conditions in the environments where people are born, live, learn, work, play, worship, and age that affect a range of health, functioning, and quality-of-life outcomes and risks,” which includes economic stability, access to quality health care, and physical environment. There is increasing evidence that SDOH have an impact in shaping a patient's access and recovery from surgery. This review evaluates the role surgeons play in reducing these disparities.

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Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery

Cited by 44 publications

References 21 publications

Association of Homelessness with Hospital Readmissions—an Analysis of Three Large States

Association of Homelessness with Hospital Readmissions—an Analysis of Three Large States

Hospital readmission among people experiencing homelessness in England: a cohort study of 2772 matched homeless and housed inpatients

Social Determinants of Health and Impact in Perioperative Space

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