A 10-year retrospective analysis of hospital admissions and length of stay among a cohort of homeless adults in Vancouver, Canada

Russolillo, Angela; Moniruzzaman, Akm; Parpouchi, Milad; Currie, Lauren; Somers, Julian M.

doi:10.1186/s12913-016-1316-7

Cited by 29 publications

(28 citation statements)

References 51 publications

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“…In our research, foreign and/or homeless patients were most often in the group with the longest hospitalizations, but without any statistically significant difference, suggesting that difficult environmental and social conditions might be one of the causes of psychiatric-delayed discharges, as the first studies on this phenomenon highlighted. 7,10,13 Nevertheless, we have to put in evidence that, in our study, this variable did not show any significant correlation with the LOSs. Among demographic variables, apart from the above-reported data, only increased age showed a significant, positive but weak, correlation with the LOSs, confirming only in part the results of other authors.…”

Section: Discussioncontrasting

confidence: 56%

“…10 Other more recent research on this phenomenon has highlighted that clinical severity and the lack of outpatient service programs were the most frequent reasons for "delayed discharges". [11][12][13] Organic comorbidity and old age represented further risk factors for long psychiatric hospitalizations, according to other authors. 14 In a recent European study, medical comorbidity was associated with increased length of stay in hospitalized psychiatric patients, after adjustment for several potential confounders.…”

Section: Introductionmentioning

confidence: 75%

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<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

Lorenzo

Montardi

Panza

et al. 2020

RMHP

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To evaluate the longest hospitalizations in an acute psychiatric ward [Service of Psychiatric Diagnosis and Treatment (SPDT)] and the related demographic, clinical and organizational variables to understand the factors that contribute to long-stay (LOS) phenomenon. The term "long stay" indicates clinical, social and organizational problems responsible for delayed discharges. In psychiatry, clinical severity, social dysfunction and/ or health-care system organization appear relevant factors in prolonging stays. Patients and Methods: We divided all the SPDT hospitalizations from 1 January 2010 to 31 December 2015 into two groups based on the 97.5 th percentile of duration: ≤36 day (n=3254) and >36 day (n=81) stays, in order to compare the two groups for the selected variables. Comparisons were made using Pearson's chi-square for categorical data and t-test for continuous variables, the correlation between the LOS, as a dependent variable, and the selected variables was analyzed in stepwise multiple linear regression and in multiple logistic regression models. Results: The longest hospitalizations were significantly related to the diagnosis of "schizophrenia and other psychosis" (Pearson Chi 2 =17.24; p=0.045), the presence of moderate and severe aggressiveness (Pearson chi 2 =29; p=0.000), compulsory treatment (Pearson Chi 2 =8.05; p=0.005), parenteral or other route administration of psycho-pharmacotherapy (Pearson Chi 2 =12.91; p=0.007), poli-therapy (Pearson Chi 2 =6.40; p=0.041), complex psychiatric activities (Pearson Chi 2 =12.26; p=0.002) and rehabilitative programs (Pearson Chi 2 =37.05; p=0.000) during the hospitalization and at discharge (Pearson Chi 2 =29.89; p=0.000). Many demographic and clinical variables were statistically significantly correlated to the LOS at our multiple linear and logistic regression model. Conclusion: In our sample, clinical illness severity and need for complex therapeutic and rehabilitative treatments were associated with prolonged psychiatric hospitalizations. Understanding this phenomenon can have not only economic but also clinical, ethical and social relevance.

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Section: Discussioncontrasting

confidence: 56%

Section: Introductionmentioning

confidence: 75%

<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

Lorenzo

Montardi

Panza

et al. 2020

RMHP

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“…Previous studies have shown that homeless persons have more hospitalizations than the general population [1, 8, 12, 17], the same can be assumed to be true for this study cohort. Having access to data from specialized care would have given us more data on the disease burden in the cohort.…”

Section: Discussionmentioning

confidence: 65%

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Stenius-Ayoade

Haaramo

Erkkila³

et al. 2017

BMC Health Serv Res

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BackgroundHomelessness is associated with increased morbidity, mortality and health care use. The aim of this study was to examine the role of mental disorders in relation to the use of 1) daytime primary health care services and 2) after hours primary health care emergency room (PHER) services among homeless shelter users in the Helsinki Metropolitan Area, Finland.MethodsThe study cohort consists of all 158 homeless persons using the four shelters operating in the study area during two selected nights. The health records were analyzed over a period of 3 years prior to the sample nights and data on morbidity and primary health care visits were gathered. We used negative binomial regression to estimate the association between mental disorders and daytime visits to primary health care and after hours visits to PHERs.ResultsDuring the 3 years the 158 homeless persons in the cohort made 1410 visits to a physician in primary health care. The cohort exhibited high rates of mental disorders, including substance use disorders (SUDs); i.e. 141 persons (89%) had a mental disorder. We found dual diagnosis, defined as SUD concurring with other mental disorder, to be strongly associated with daytime primary health care utilization (IRR 11.0, 95% CI 5.9–20.6) when compared with those without any mental disorder diagnosis. The association was somewhat weaker for those with only SUDs (IRR 4.9, 95% CI 2.5–9.9) or with only other mental disorders (IRR 5.0, 95% CI 2.4–10.8). When focusing upon the after hours visits to PHERs we observed that both dual diagnosis (IRR 14.1, 95% CI 6.3–31.2) and SUDs (11.5, 95% CI 5.7–23.3) were strongly associated with utilization of PHERs compared to those without any mental disorder. In spite of a high numbers of visits, we found undertreatment of chronic conditions such as hypertension and diabetes.ConclusionsDual diagnosis is particularly strongly associated with primary health care daytime visits among homeless persons staying in shelters, while after hours visits to primary health care level emergency rooms are strongly associated with both dual diagnosis and SUDs. Active treatment for SUDs could reduce the amount of emergency visits made by homeless shelter users.

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“…Hwang et al noted that in Canada, even after adjustment for age, gender, and resource intensity weight, hospitalizations for IEH cost over $2500 more than for housed individuals [12]. Concomitant mental health concerns are common in IEH and impact both rates of hospital admissions, LOS, and hospitalization costs [14], with admissions to psychiatry costing over $1000 more for IEH (even while adjusting for length of stay) [12].…”

Section: Introductionmentioning

confidence: 99%

Illnesses Associated With Increased Length of Stay for Individuals Experiencing Homelessness: A Retrospective Cohort Study of Emergency Department Visits and Hospitalizations.

Ghosh

Sikdar

Koleade

et al. 2020

Preprint

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Background: Individuals experiencing homelessness (IEH) tend to have increased length of stay (LOS) in acute care settings, which negatively impacts health care costs and resource utilization. It is unclear however, what specific factors account for this increased LOS. This study attempts to define which diagnoses most impact LOS for IEH and if there are differences based on their demographics. Methods: A retrospective cohort study was conducted looking at ICD-10 diagnosis codes and LOS for patients identified as IEH seen in Emergency Departments (ED) and also for those admitted to. Data were stratified based on diagnosis, gender and age. Statistical analysis was conducted to determine which ICD-10 diagnoses were significantly associated with increased ED and inpatient LOS for IEH compared to housed individuals.Results: Homelessness admissions were associated with increased LOS regardless of gender or age group. The absolute mean difference of LOS between IEH and housed individuals was 1.62 hours [95% CI 1.49 – 1.75] in the ED and 3.02 days [95% CI 2.42-3.62] for inpatients. Males age 18-24 years spent on average 7.12 more days in hospital, and females aged 25-34 spent 7.32 more days in hospital compared to their housed counterparts. Thirty-one diagnoses were associated with increased LOS in EDs for IEH compared to their housed counterparts; maternity concerns and coronary artery disease were associated with significantly increased inpatient LOS. Conclusion: Homelessness significantly increases the LOS of individuals within both ED and inpatient settings. We have identified numerous diagnoses that are associated with increased LOS in IE; these inform the prioritization and development of targeted interventions to improve the health of IEH.

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A 10-year retrospective analysis of hospital admissions and length of stay among a cohort of homeless adults in Vancouver, Canada

Cited by 29 publications

References 51 publications

<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

<p>Retrospective Analysis of Factors Associated with Long-Stay Hospitalizations in an Acute Psychiatric Ward</p>

Mental disorders and the use of primary health care services among homeless shelter users in the Helsinki metropolitan area, Finland

Illnesses Associated With Increased Length of Stay for Individuals Experiencing Homelessness: A Retrospective Cohort Study of Emergency Department Visits and Hospitalizations.

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