Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department

Moore, Gaye, Hepworth, Graham, Weiland, Tracey, Manias, Elizabeth, Gerdtz, Marie Frances, Kelaher, Margaret and Dunt, David 2012, Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department, Australasian emergency nursing journal, vol. 15, no. 1, pp. 2-13, doi: 10.1016/j.aenj.2011.12.004.

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Title Prospective validation of a predictive model that identifies homeless people at risk of re-presentation to the emergency department
Author(s) Moore, Gaye
Hepworth, Graham
Weiland, Tracey
Manias, ElizabethORCID iD for Manias, Elizabeth
Gerdtz, Marie Frances
Kelaher, Margaret
Dunt, David
Journal name Australasian emergency nursing journal
Volume number 15
Issue number 1
Start page 2
End page 13
Total pages 12
Publisher Elsevier
Place of publication London, Eng.
Publication date 2012-02
ISSN 1574-6267
Keyword(s) emergency department
homeless people
hospital re-presentation
risk screening
Cohort Studies
Emergency Service, Hospital
Homeless Persons
Hospitals, Public
Hospitals, Urban
Mental Disorders
Mental Health
Models, Statistical
Patient Acceptance of Health Care
Patient Readmission
Prospective Studies
Risk Assessment
Risk Factors
Socioeconomic Factors
Substance-Related Disorders
Urban Population
Wounds and Injuries
Summary OBJECTIVE: To prospectively evaluate the accuracy of a predictive model to identify homeless people at risk of representation to an emergency department.

METHODS: A prospective cohort analysis utilised one month of data from a Principal Referral Hospital in Melbourne, Australia. All visits involving people classified as homeless were included, excluding those who died. Homelessness was defined as living on the streets, in crisis accommodation, in boarding houses or residing in unstable housing. Rates of re-presentation, defined as the total number of visits to the same emergency department within 28 days of discharge from hospital, were measured. Performance of the risk screening tool was assessed by calculating sensitivity, specificity, positive and negative predictive values and likelihood ratios.

RESULTS: Over the study period (April 1, 2009 to April 30, 2009), 3298 presentations from 2888 individuals were recorded. The homeless population accounted for 10% (n=327) of all visits and 7% (n=211) of all patients. A total of 90 (43%) homeless people re-presented to the emergency department. The predictive model included nine variables and achieved 98% (CI, 0.92-0.99) sensitivity and 66% (CI, 0.57-0.74) specificity. The positive predictive value was 68% and the negative predictive value was 98%. The positive likelihood ratio 2.9 (CI, 2.2-3.7) and the negative likelihood ratio was 0.03 (CI, 0.01-0.13).

CONCLUSION: The high emergency department re-presentation rate for people who were homeless identifies unresolved psychosocial health needs. The emergency department remains a vital access point for homeless people, particularly after hours. The risk screening tool is key to identify medical and social aspects of a homeless patient's presentation to assist early identification and referral.
Language eng
DOI 10.1016/j.aenj.2011.12.004
Field of Research 111099 Nursing not elsewhere classified
1110 Nursing
1117 Public Health And Health Services
Socio Economic Objective 970111 Expanding Knowledge in the Medical and Health Sciences
HERDC Research category C1.1 Refereed article in a scholarly journal
ERA Research output type C Journal article
Copyright notice ©2012, College of Emergency Nursing Australasia
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