The revolving hospital door: Hospital readmissions among patients who are homeless

Kelly Doran, Kyle T. Ragins, Andrea L. Iacomacci, Alison Cunningham, Karen J. Jubanyik, Grace Y. Jenq

Research output: Contribution to journalArticle

Abstract

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.

Original languageEnglish (US)
Pages (from-to)767-773
Number of pages7
JournalMedical Care
Volume51
Issue number9
DOIs
StatePublished - Sep 2013

Fingerprint

Patient Readmission
Inpatients
Hospitalization
Homeless Persons
Electronic Health Records
Urban Hospitals
Medicaid
Research
Hospital Emergency Service
Patient Care
Observation
Population

Keywords

  • Homelessness
  • Hospital quality
  • Readmissions

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health

Cite this

Doran, K., Ragins, K. T., Iacomacci, A. L., Cunningham, A., Jubanyik, K. J., & Jenq, G. Y. (2013). The revolving hospital door: Hospital readmissions among patients who are homeless. Medical Care, 51(9), 767-773. https://doi.org/10.1097/MLR.0b013e31829fafbb

The revolving hospital door : Hospital readmissions among patients who are homeless. / Doran, Kelly; Ragins, Kyle T.; Iacomacci, Andrea L.; Cunningham, Alison; Jubanyik, Karen J.; Jenq, Grace Y.

In: Medical Care, Vol. 51, No. 9, 09.2013, p. 767-773.

Research output: Contribution to journalArticle

Doran, K, Ragins, KT, Iacomacci, AL, Cunningham, A, Jubanyik, KJ & Jenq, GY 2013, 'The revolving hospital door: Hospital readmissions among patients who are homeless', Medical Care, vol. 51, no. 9, pp. 767-773. https://doi.org/10.1097/MLR.0b013e31829fafbb
Doran, Kelly ; Ragins, Kyle T. ; Iacomacci, Andrea L. ; Cunningham, Alison ; Jubanyik, Karen J. ; Jenq, Grace Y. / The revolving hospital door : Hospital readmissions among patients who are homeless. In: Medical Care. 2013 ; Vol. 51, No. 9. pp. 767-773.
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