Factors Associated with Readmission Among General Internal Medicine Patients Experiencing Homelessness

Abstract

Background

People who are homeless have a higher burden of illness and higher rates of hospital admission and readmission compared to the general population. Identifying the factors associated with hospital readmission could help healthcare providers and policymakers improve post-discharge care for homeless patients.

Objective

To identify factors associated with hospital readmission within 90 days of discharge from a general internal medicine unit among patients experiencing homelessness.

Design

This prospective observational study was conducted at an urban academic teaching hospital in Toronto, Canada. Interviewer-administered questionnaires and chart reviews were completed to assess medical, social, processes of care, and hospitalization data. Multivariable logistic regression with backward selection was used to identify factors associated with a subsequent readmission and estimate odds ratios and 95% confidence intervals.

Participants

Adults (N = 129) who were admitted to the general internal medicine service between November 2017 and November 2018 and who were homeless at the time of admission.

Main Measures

Unplanned all-cause readmission to the study hospital within 90 days of discharge.

Key Results

Thirty-five of 129 participants (27.1%) were readmitted within 90 days of discharge. Factors associated with lower odds of readmission included having an active case manager (adjusted odds ratios [aOR]: 0.31, 95% CI, 0.13–0.76), having informal support such as friends and family (aOR: 0.25, 95% CI, 0.08–0.78), and sending a copy of the patient’s discharge plan to a primary care physician who had cared for the patient within the last year (aOR: 0.44, 95% CI, 0.17–1.16). A higher number of medications prescribed at discharge was associated with higher odds of readmission (aOR: 1.12, 95% CI, 1.02–1.23).

Conclusion

Interventions to reduce hospital readmission for people who are homeless should evaluate tailored discharge planning and dedicated resources to support implementation of these plans in the community.

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Data Availability

The datasets analyzed during the current study are available from the corresponding author upon reasonable request.

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Acknowledgments

The authors thank the participants of this study for sharing their experiences, information, and their time with us; the staff of St. Michael’s Hospital general internal medicine ward for their assistance with recruitment; Dr. Yayi Huang for her contribution to developing the study protocol; and the Survey Research Unit at the MAP Centre for Urban Health Solutions, in particular Paula Smith and Sonia Zawitkowski, who coordinated and administered questionnaires with patients and completed patient chart reviews.

Funding

This study was supported by funding from the St. Michael’s Hospital Foundation.

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Correspondence to Stephen W. Hwang MD.

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This study was approved by the St. Michael’s Hospital (now Unity Health Toronto) Research Ethics Board.

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The authors declare that they do not have a conflict of interest.

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Wang, A., Pridham, K.F., Nisenbaum, R. et al. Factors Associated with Readmission Among General Internal Medicine Patients Experiencing Homelessness. J GEN INTERN MED (2021). https://doi.org/10.1007/s11606-020-06483-w

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KEY WORDS

  • homeless persons
  • patient readmission
  • hospitalization
  • health services
  • poverty