The Revolving Hospital Door: Hospital Readmissions Among Patients Who Are Homeless

• Published in: Medical care 2013-09, Vol.51 (9), p.767-773
• Main Authors: Doran, Kelly M., Ragins, Kyle T., Iacomacci, Andrea L., Cunningham, Alison, Jubanyik, Karen J., Jenq, Grace Y.
• Format: Article
• Language: English
• Subjects: Female; Health care industry; Homeless people; Homeless Persons - statistics & numerical data; Homelessness; Hospital admissions; Hospitalization; Hospitals; Housing; Humans; Length of Stay; Male; Medicaid; Medicaid - statistics & numerical data; Medical records; Middle Aged; Patient admissions; Patient Readmission - statistics & numerical data; Psychiatric hospitals; Retrospective Studies; Shelters; Studies; Teaching hospitals; United States
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0b013e31829fafbb

Background: National attention is increasingly focused on hospital readmissions. Little prior research has examined readmissions among patients who are homeless. Objective: The aim of the study was to determine 30-day hospital readmission rates among patients who are homeless and examine factors associated with hospital readmissions in this population. Methods: We conducted a retrospective chart review of patients who were homeless and hospitalized at a single urban hospital from May-August 2012. Homelessness was identified by an electronic medical record flag and confirmed by manual chart review. The primary outcome was all-cause hospital readmission to the study hospital within 30 days of hospital discharge. Patient-level and hospitalization-level factors associated with risk for readmission were examined using generalized estimating equations. Results: There were 113 unique patients who were homeless and admitted to the hospital a total of 266 times during the study period. The mean age was 49 years, 27.4% of patients were women, and 75.2% had Medicaid. Half (50.8%) of all hospitalizations resulted in a 30-day hospital inpatient readmission and 70.3% resulted in either an inpatient readmission, observation status stay, or emergency department visit within 30 days of hospital discharge. Most readmissions occurred early after hospital discharge (53.9% within 1 week, 74.8% within 2 weeks). Discharge to the streets or shelter versus other living situations was associated with increased risk for readmission in multivariable analyses. Conclusions: Patients who were homeless had strikingly high 30-day hospital readmission rates. These findings suggest the urgent need for further research and interventions to improve postdischarge care for patients who are homeless.