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- Title
Characteristics and Health Care Utilization of Patients With Housing Insecurity in the ED.
- Authors
Ball, Madeleine A. Z.; Sack, Daniel E.; Druffner, Sophia A.; Jones, Ian; Wrenn, Jesse O.; Sexton, Mitchell M.; Shinn, Marybeth; Hess, Jennifer J.
- Abstract
Key Points: Question: What is the scope of housing insecurity for patients presenting to a major emergency department in the Southeast US? Findings: In this cross-sectional study of 23 795 emergency department visits, in 5% of visits, patients screened positive for housing insecurity. Patients experiencing homelessness were more likely to present with a chief concern of suicide, to be uninsured, and to have multiple visits during the study period. Meaning: This study supports screening for homelessness in emergency departments, directing resources toward mental health care, and focusing on high utilization as vital steps in optimizing care for patients with housing insecurity. Importance: Unstable housing and homelessness can exacerbate adverse health outcomes leading to increased risk of chronic disease, injury, and disability. However, emergency departments (EDs) have no universal method to identify those at risk of or currently experiencing homelessness. Objective: To describe the extent of housing insecurity among patients who seek care in an urban ED, including chief concerns, demographics, and patterns of health care utilization. Design, Setting, and Participants: This cross-sectional study included all adult patients presenting to the ED at Vanderbilt University Medical Center (VUMC), an urban tertiary care, level I trauma center in the Southeast US, from January 5 to May 16, 2023. Main Outcomes and Measures: The primary outcome was the proportion of ED visits at which patients screened positive for housing insecurity. Secondary outcomes included prevalence of insecurity by chief concerns, demographics, and patterns of health care utilization. Results: Of all 23 795 VUMC ED visits with screenings for housing insecurity (12 465 visits among women [52%]; median age, 47 years [IQR, 32-48 years]), in 1185 (5%), patients screened positive for current homelessness or housing insecurity (660 unique patients); at 22 610 visits (95%), the screening result was negative. Of visits with positive results, the median age of patients was 46 years (IQR, 36-55 years) and 829 (70%) were among male patients. Suicide and intoxication were more common chief concerns among visits at which patients screened positive (132 [11%] and 118 [10%], respectively) than among those at which patients screened negative (220 [1%] and 335 [2%], respectively). Visits with positive results were more likely to be among patients who were uninsured (395 [33%] vs 2272 [10%]) and had multiple visits during the study period. A higher proportion of positive screening results occurred between 8 pm and 6 am. The social work team assessed patients at 919 visits (78%) with positive screening results. Conclusions and Relevance: In this cross-sectional study of 23 795 ED visits, at 5% of visits, patients screened positive for housing insecurity and were more likely to present with a chief concern of suicide, to be uninsured, and to have multiple visits during the study period. This analysis provides a call for other institutions to introduce screening and create tailored care plans for patients experiencing housing insecurity to achieve equitable health care. This cross-sectional study describes the proportion of emergency department (ED) visits at which patients tested positive for housing insecurity.
- Subjects
UNITED States; SOUTHERN States; MEDICAL care use; CROSS-sectional method; HEALTH services accessibility; SUBSTANCE abuse; ACADEMIC medical centers; RESEARCH funding; PATIENTS; MENTAL illness; EMERGENCY room visits; QUESTIONNAIRES; HOSPITAL emergency services; DISEASE prevalence; DESCRIPTIVE statistics; EMERGENCY medical services; METROPOLITAN areas; HOMELESS persons; SUICIDE; HOMELESSNESS; HOUSING stability; SOCIODEMOGRAPHIC factors; COMPARATIVE studies; PSYCHOSOCIAL factors; POVERTY
- Publication
JAMA Network Open, 2024, Vol 7, Issue 1, pe248565
- ISSN
2574-3805
- Publication type
Article
- DOI
10.1001/jamanetworkopen.2024.8565