Article Text

PDF
Homelessness: patterns of emergency department use and risk factors for re-presentation
  1. G Moore1,
  2. M F Gerdtz1,
  3. G Hepworth2,
  4. E Manias1
  1. 1Melbourne School of Health Sciences, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria, Australia
  2. 2Department of Mathematics and Statistics, Statistical Consulting Centre, The University of Melbourne, Victoria, Australia
  1. Correspondence to Dr Gaye Moore, Centre for Palliative Care Education and Research, PO Box 2900, 6 Gertrude St, Fitzroy, VIC 3065, Australia; dgmoore{at}optusnet.com.au

Abstract

Objectives 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.

  • Emergency department
  • homeless
  • hospital re-presentation
  • risk screening
  • behavioural model for vulnerable populations
  • clinical assessment, effectiveness
  • education, assessment
  • mental health, mental illness
  • mental health, drug abuse
  • nursing, emergency departments

Statistics from Altmetric.com

Footnotes

  • Funding Financial support was provided through the Australian Research Council Linkage Project Scheme, project number LP0453587. Financial support was also provided by St Vincent's Hospital.

  • Competing interests None.

  • Ethics approval This study was conducted with the approval of St Vincent's Hospital, Melbourne, Australia.

  • Provenance and peer review Not commissioned; externally peer reviewed.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Primary survey
    Darren Walter