When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers

Treglia, Dan; Johns, Eileen; Schretzman, Maryanne; Berman, Jacob; Culhane, Dennis P; Lee, Dong Hoon; Doran, Kelly M.

doi:10.1377/hlthaff.2018.05308

Cited by 13 publications

(20 citation statements)

References 24 publications

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“…No prior research has considered homelessness prevention in ED settings despite EDs serving large numbers of patients who may be at risk for future homelessness. 8 We previously found spikes in ED visits in the days and weeks immediately preceding shelter entry, 18 suggesting the importance of future efforts to screen for homelessness risk and refer to prevention services. 19,20 Notably, 13.7% of individuals in our sample were homeless at baseline, and many patients identified as future shelter entrants had past shelter stays.…”

Section: Discussionmentioning

confidence: 99%

Development of a homelessness risk screening tool for emergency department patients

Doran

Johns

Zuiderveen³

et al. 2021

Health Services Research

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Objective: To develop a screening tool to identify emergency department (ED) patients at risk of entering a homeless shelter, which could inform targeting of interventions to prevent future homelessness episodes. Data sources: Linked data from (1) ED patient baseline questionnaires and (2) citywide administrative homeless shelter database. Study design: Stakeholder-informed predictive modeling utilizing ED patient questionnaires linked with prospective shelter administrative data. The outcome was shelter entry documented in administrative data within 6 months following the baseline ED visit. Exposures were responses to questions on homelessness risk factors from baseline questionnaires.Data collection/extraction methods: Research assistants completed questionnaires with randomly sampled ED patients who were medically stable, not in police/prison custody, and spoke English or Spanish. Questionnaires were linked to administrative data using deterministic and probabilistic matching.

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Section: Discussionmentioning

confidence: 99%

Development of a homelessness risk screening tool for emergency department patients

Doran

Johns

Zuiderveen³

et al. 2021

Health Services Research

Self Cite

View full text Add to dashboard Cite

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“…Some researchers have questioned the accuracy of the homelessness flag 31,32 . Some other studies have linked Medicaid or all‐payer claims data to administrative records from homelessness‐related programs 54,55 . Yet, most of these studies only included homeless people in the analysis.…”

Section: Discussionmentioning

confidence: 99%

“…31,32 Some other studies have linked Medicaid or all-payer claims data to administrative records from homelessness-related programs. 54,55 Yet, most of these studies only included homeless people in the analysis. In addition, Medicaid complex and high utilizer NBEH are more comparable to BEH than the general low-income population and the overall housed Medicaid enrollees used in prior studies.…”

Section: Discussionmentioning

confidence: 99%

Differential associations of homelessness with emergency department visits and hospitalizations by race, ethnicity, and gender

Yue

Pourat

Essien

et al. 2022

Health Services Research

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Objective To investigate the differential associations of homelessness with emergency department (ED) visits and hospitalizations by race, ethnicity, and gender. Data Sources California Medicaid enrollment and claims. Study Design We identified beneficiaries experiencing homelessness (BEH) and those who did not (NBEH) using diagnosis and place of service codes and residential addresses. Outcomes include four ED visit measures and four hospitalization measures. We compared the use of these services by BEH to NBEH overall and by race, ethnicity, and gender groups in regression models controlling for covariates. Data Collection We used a sample of Medicaid beneficiaries who met eligibility criteria for a California Medicaid demonstration program in 2017 and 2018 but were not enrolled in the program. We identified 473,069 BEH, and the rest (1,948,422) were considered NBEH. We used the 2018 data for utilization analyses and most covariates. We constructed lagged measures of health conditions using 2017 data. Principal Findings We found that homelessness was significantly associated with 0.34 more ED visits (p < 0.01) and a higher likelihood of frequent ED visits (2.77 percentage points [pp], p < 0.01), any ED visits due to mental health conditions (0.79 pp, p < 0.01), and any ED visits due to substance use disorders (1.47 pp, p < 0.01). Experiencing homelessness was also significantly associated with 0.03 more hospitalizations (p < 0.01), a higher likelihood of frequent hospitalizations (0.68 pp, p < 0.01) and high frequent hospitalizations (0.28 pp, p < 0.01), and a longer length of stay (0.53 days, p < 0.01). We found a larger association for American Indian and Alaska Native, Black, Native Hawaii or Pacific Islander, and White populations than that for Asian and Hispanic populations. The associations are larger for males than females. Conclusions Our findings identified distinct utilization patterns by race, ethnicity, and gender. They indicated the need for developing race, ethnicity, and gender‐specific strategies to reduce ED visits and hospitalizations of BEH.

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“…These increases may reflect patterns of care that facilitate entry into PSH and are consistent with prior research that ED and inpatient use increases immediately before and after homeless adults enter shelters. 34 To the extent homeless individuals become connected to housing providers as a result of using care-whose costs may be borne by Medicaid-there may be an opportunity for Medicaid programs to proactively identify homeless individuals who are eligible for PSH before they incur costly care. Expansions of Medicaid under the Affordable Care Act have increased insurance coverage among homeless individuals, increasing the incentive for Medicaid programs to identify homeless individuals who may be candidates for PSH prior to incidents that require expensive and complex care.…”

Section: Discussionmentioning

confidence: 99%

Changes in Medicaid Utilization and Spending Associated with Homeless Adults’ Entry into Permanent Supportive Housing

et al. 2021

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BACKGROUND: There is growing interest in financing housing and supportive services for homeless individuals through Medicaid. Permanent Supportive Housing (PSH), which integrates non-time-limited housing with supportive services for people who are disabled and chronically homeless, has seen rapid growth in the last decade, but clear evidence on the long-term impacts of PSH, needed to guide state efforts to finance some PSH services through Medicaid, is lacking. OBJECTIVE: Assess changes in Medicaid expenditures and utilization associated with receiving PSH. DESIGN: Cohort study using a difference-in-differences approach. PARTICIPANTS: A total of 1226 PA Medicaid enrollees who entered PSH 2011-2016 and remained in PSH for 180 days or more, and a matched comparison cohort of 970 enrollees experiencing housing instability who did not receive PSH. MAIN MEASURES: Medicaid spending in aggregate, and on behavioral and physical health services; emergency department (ED) visits and inpatient hospital stays. KEY RESULTS: Three years after PSH entry, spending decreased by an average of $145/month in the PSH cohort relative to changes in the comparison cohort (p = 0.046), with the greatest relative spending reductions occurring for residential behavioral health ($64, p < 0.001) and inpatient non-behavioral health services ($89, p = 0.001). We also found relative reductions in ED use (4.7 visits/100 person-months, p = 0.010) and inpatient hospital stays (1.6 visits/100 person-months, p < 0.001). CONCLUSIONS: These results can inform emerging state efforts to finance PSH services through Medicaid. Additional state expenditures to expand financing for PSH services could be partially offset by reductions in Medicaid spending, in part by facilitating a shift in treatment to outpatient from acute care settings.

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When Crises Converge: Hospital Visits Before And After Shelter Use Among Homeless New Yorkers

Cited by 13 publications

References 24 publications

Development of a homelessness risk screening tool for emergency department patients

Development of a homelessness risk screening tool for emergency department patients

Differential associations of homelessness with emergency department visits and hospitalizations by race, ethnicity, and gender

Changes in Medicaid Utilization and Spending Associated with Homeless Adults’ Entry into Permanent Supportive Housing

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