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

• Published in: Medical care Vol. 51; no. 9; p. 767
• Main Authors: Doran, Kelly M, Ragins, Kyle T, Iacomacci, Andrea L, Cunningham, Alison, Jubanyik, Karen J, Jenq, Grace Y
• Format: Journal Article
• Language: English
• Published: United States 01.09.2013
• Subjects: Female; Homeless Persons - statistics & numerical data; Humans; Length of Stay; Male; Medicaid - statistics & numerical data; Middle Aged; Patient Readmission - statistics & numerical data; Retrospective Studies; United States; United States
• ISSN: 1537-1948
• DOI: 10.1097/MLR.0b013e31829fafbb

National attention is increasingly focused on hospital readmissions. Little prior research has examined readmissions among patients who are homeless. 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. 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. 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. 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.