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Findings of a national dataset analysis on the visits of homeless patients to US emergency departments during 2005-2015.

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Name of journal: Public healthAbstract: CONCLUSIONS: Less than one in 100 US ED visits in 2005-2015 were made by homeless patients. Compared with the non-homeless, homeless patients had greatly increased rates of ED care for alcohol-related, substance abuse-related, and mental health-related problems, particularly schizophrenia and personality disorders. Homeless patients were also more likely to be seen in the ED within the past 72 h or the past 12 months. Homeless patients were more likely to be admitted to the hospital and, when admitted, exhibited longer stay times. Copyright (c) 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.METHODS: Patient visits were classified as homeless or non-homeless based on survey data; appropriate statistical analyses were subsequently performed to compare these groups in terms of patient demographics, geography, payment method, resource utilization/diagnostic service use, as well as both psychiatric and non-psychiatric diagnoses received in the ED.OBJECTIVES: To our knowledge, there has been limited description of emergency department (ED) visits involving homeless patients over the last decade. Our study aims to analyze US national survey data to elucidate the differences between homeless and non-homeless patients' ED visits in terms of patient demographics, resource utilization, and diagnoses received.RESULTS: NHAMCS data from 2005 to 2015 were aggregated. In total, 303,326 patient visits were included, which represent an estimated 1.30 billion ED visits over this period. Of these, 2750 encounters were by homeless people, representing 8,781,925 ED visits. Compared with non-homeless visits, homeless patients were disproportionately male, black, non-Hispanic, and seen in large metropolitan areas or the Western/Southern US. Homeless visits were more likely to be related to an injury (47.5% vs. 33.8%), related to an assault (4.2% vs. 1.3%), or self-inflicted (4.8% vs 0.84%). Homeless patients were also more likely to have been seen in the same ED within 72 h (7.3% vs. 3.9%) compared with non-homeless patients (3.9%, 95% confidence interval [CI]: 3.5-4.4) and were seen an average of 5.7 times (95% CI: 4.7-6.8) in the same ED over the preceding 12 months, with non-homeless patients seen an average of 3.2 times (95% CI: 3.1-3.4). Homeless patients were more likely to be admitted to the hospital (14.9% vs. 11.2%) and, when admitted, spent an average of 6.3 days in the hospital (95% CI: 5.6-7.1) compared with non-homeless patients at 5.2 (95% CI: 5.1-5.3). In total, 28.4% of homeless patients received a psychiatric diagnosis (95% CI: 25.8-31.2) compared with 5.4% for non-homeless patients (95% CI: 5.2-5.7, P < 0.001). In reference to non-homeless visits, homeless visits showed increased odds of alcohol-related diagnoses (odds ratio [OR]: 17.3, 95% CI: 10.1-29.8, P < 0.001) and substance abuse diagnoses (OR: 8.4, 95% CI: 7.2-9.8, P < 0.001). Homeless visits also exhibited greatly increased odds of diagnosis of schizophrenia (OR: 16.6, 95% CI: 12.6-22.5, P < 0.001) and personality disorders (OR: 15.4, 95% CI: 6.4-36.9, P < 0.001).STUDY DESIGN: This was a retrospective study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 until 2015.All authors: Lombardi K, Mazer-Amirshahi M, Pines JM, Pourmand AOriginally published: Public Health. 178:82-89, 2019 Oct 20.Fiscal year: FY2020Digital Object Identifier:

https://dx.doi.org/10.1016/j.puhe.2019.09.003

Date added to catalog: 2019-11-05

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Item type	Current library	Collection	Call number	Status	Date due	Barcode
Journal Article	MedStar Authors Catalog	Article	31644986	Available		31644986

CONCLUSIONS: Less than one in 100 US ED visits in 2005-2015 were made by homeless patients. Compared with the non-homeless, homeless patients had greatly increased rates of ED care for alcohol-related, substance abuse-related, and mental health-related problems, particularly schizophrenia and personality disorders. Homeless patients were also more likely to be seen in the ED within the past 72 h or the past 12 months. Homeless patients were more likely to be admitted to the hospital and, when admitted, exhibited longer stay times. Copyright (c) 2019 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

METHODS: Patient visits were classified as homeless or non-homeless based on survey data; appropriate statistical analyses were subsequently performed to compare these groups in terms of patient demographics, geography, payment method, resource utilization/diagnostic service use, as well as both psychiatric and non-psychiatric diagnoses received in the ED.

OBJECTIVES: To our knowledge, there has been limited description of emergency department (ED) visits involving homeless patients over the last decade. Our study aims to analyze US national survey data to elucidate the differences between homeless and non-homeless patients' ED visits in terms of patient demographics, resource utilization, and diagnoses received.

RESULTS: NHAMCS data from 2005 to 2015 were aggregated. In total, 303,326 patient visits were included, which represent an estimated 1.30 billion ED visits over this period. Of these, 2750 encounters were by homeless people, representing 8,781,925 ED visits. Compared with non-homeless visits, homeless patients were disproportionately male, black, non-Hispanic, and seen in large metropolitan areas or the Western/Southern US. Homeless visits were more likely to be related to an injury (47.5% vs. 33.8%), related to an assault (4.2% vs. 1.3%), or self-inflicted (4.8% vs 0.84%). Homeless patients were also more likely to have been seen in the same ED within 72 h (7.3% vs. 3.9%) compared with non-homeless patients (3.9%, 95% confidence interval [CI]: 3.5-4.4) and were seen an average of 5.7 times (95% CI: 4.7-6.8) in the same ED over the preceding 12 months, with non-homeless patients seen an average of 3.2 times (95% CI: 3.1-3.4). Homeless patients were more likely to be admitted to the hospital (14.9% vs. 11.2%) and, when admitted, spent an average of 6.3 days in the hospital (95% CI: 5.6-7.1) compared with non-homeless patients at 5.2 (95% CI: 5.1-5.3). In total, 28.4% of homeless patients received a psychiatric diagnosis (95% CI: 25.8-31.2) compared with 5.4% for non-homeless patients (95% CI: 5.2-5.7, P < 0.001). In reference to non-homeless visits, homeless visits showed increased odds of alcohol-related diagnoses (odds ratio [OR]: 17.3, 95% CI: 10.1-29.8, P < 0.001) and substance abuse diagnoses (OR: 8.4, 95% CI: 7.2-9.8, P < 0.001). Homeless visits also exhibited greatly increased odds of diagnosis of schizophrenia (OR: 16.6, 95% CI: 12.6-22.5, P < 0.001) and personality disorders (OR: 15.4, 95% CI: 6.4-36.9, P < 0.001).

STUDY DESIGN: This was a retrospective study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 until 2015.

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