File(s) under permanent embargo
Homelessness: patterns of emergency department use and risk factors for re-presentation
journal contribution
posted on 2011-05-01, 00:00 authored by G Moore, M F Gerdtz, G Hepworth, Elizabeth ManiasElizabeth ManiasOBJECTIVES: To describe patterns of service use and to predict risk factors for re-presentation to a metropolitan emergency department (ED) among people who are homeless. METHODS: A retrospective cohort analysis was undertaken over a 24-month period from a principal referral hospital in Melbourne, Australia. All ED visits relating to people classified as homeless were included. A predictive model for risk of re-presentation was developed using logistic regression with random effects. Rates of re-presentation, defined as the total number of visits to the same ED within 28 days of discharge, were measured. RESULTS: The study period was 1 January 2003 to 31 December 2004. The re-presentation rate for homeless people was 47.8% (3199/6689) of ED visits and 45.5% (725/1595) of the patients. The final predictive model included risk factors, which incorporated both hospital and community service use. Those characteristics that resulted in significantly increased odds of re-presentation were leaving hospital at own risk (OR 1.31; 95% CI 1.10 to 1.56), treatment in another hospital (OR 1.45, 95% CI 1.23 to 1.72) and being in receipt of community-based case management (OR 1.31, 95% CI 1.11 to 1.54) or pension (OR 1.34, 95% CI 1.12 to 1.62). CONCLUSIONS: The predictive model identified nine risk factors of re-presentation to the ED for people who are homeless. Early identification of these factors among homeless people may alert clinicians to the complexity of issues influencing an individual ED visit. This information can be used at admission and discharge by ensuring that homeless people have access to services commensurate with their health needs. Improved linkage between community and hospital services must be underscored by the capacity to provide safe and secure housing.
History
Journal
Emergency medicine journalVolume
28Issue
5Pagination
422 - 427Publisher
BMJ GroupLocation
London, Eng.Publisher DOI
eISSN
1472-0213Language
engPublication classification
C Journal article; C1.1 Refereed article in a scholarly journalCopyright notice
2011, BMJ Publishing GroupUsage metrics
Categories
No categories selectedKeywords
AdultEmergency Service, HospitalFemaleHomeless PersonsHospitals, UrbanHumansLinear ModelsLogistic ModelsMalePatient Acceptance of Health CarePatient ReadmissionRetrospective StudiesRisk FactorsVictoriaScience & TechnologyLife Sciences & BiomedicineEmergency MedicineBEHAVIORAL-MODELCASE-MANAGEMENTHEALTH-CAREBARRIERSOUTCOMES
Licence
Exports
RefWorks
BibTeX
Ref. manager
Endnote
DataCite
NLM
DC