Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation
Abstract Background UK “Pathway” teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet “homelessness” is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunit...
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| Format: | Article |
| Language: | English |
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BMC
2019-11-01
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| Series: | BMC Health Services Research |
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| Online Access: | http://link.springer.com/article/10.1186/s12913-019-4620-1 |
| _version_ | 1818936757403516928 |
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| author | Hannah Field Briony Hudson Nigel Hewett Zana Khan |
| author_facet | Hannah Field Briony Hudson Nigel Hewett Zana Khan |
| author_sort | Hannah Field |
| collection | DOAJ |
| description | Abstract Background UK “Pathway” teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet “homelessness” is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless. Methods Retrospective analysis of patients referred to “Pathway” homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected. Results A total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission. Conclusions Disengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions. |
| first_indexed | 2024-12-20T05:41:08Z |
| format | Article |
| id | doaj.art-3263a611bb8c4b2aa81ce468a2853a90 |
| institution | Directory Open Access Journal |
| issn | 1472-6963 |
| language | English |
| last_indexed | 2024-12-20T05:41:08Z |
| publishDate | 2019-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Health Services Research |
| spelling | doaj.art-3263a611bb8c4b2aa81ce468a2853a902022-12-21T19:51:26ZengBMCBMC Health Services Research1472-69632019-11-0119111510.1186/s12913-019-4620-1Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluationHannah Field0Briony Hudson1Nigel Hewett2Zana Khan3Royal Surrey County HospitalPathwayPathwayPathwayAbstract Background UK “Pathway” teams offer specialist hospital care coordination for people experiencing homelessness. Emergency healthcare use is high among homeless people, yet “homelessness” is not routinely coded in National Health Service (NHS) data. Pathway team records provide an opportunity to assess patterns in admissions and outcomes for inpatients identified as homeless. Methods Retrospective analysis of patients referred to “Pathway” homelessness teams in seven UK hospitals to explore the patterns of hospital admission, morbidity, secondary healthcare utilisation and housing status. Each patient was individually identified as experiencing homelessness. Within a six-month period, demographic data, reason for admission, morbidity, mortality and secondary care hospital usage 120-days before and 120-days after the index admission was collected. Results A total of 1009 patients were referred, resulting in 1135 admissions. Most admissions had an acute physical health need (94.9%). Co-morbid mental illness and/or substance misuse was common (55.7%). Reasons for admission included mental and behavioral disorders (overdose, alcohol withdrawal or depression, 28.3%), external causes of morbidity and mortality (assault or trauma, 18.7%), and injury, poisoning and external causes (head injury, falls and fractures, 12.4%). Unplanned Emergency Department attendances reduced after index admission and unplanned hospital admissions increased slightly. Planned admissions doubled and total bed days increased. Housing status was maintained or improved for over 60% of inpatients upon discharge. Within 12 months of index admission, 50 patients (5%) died, 15 deaths (30%) occurred during the index admission. Conclusions Disengagement with health services is common among homeless people. Many deaths are due to treatable medical conditions (heart disease, pneumonia, cancer). Observed increases in planned admissions suggests intervention from Pathway teams facilitates necessary investigations and treatment for homeless people. Equity, parity of care, and value should be inbuilt interventions for inclusion health groups and evaluations need to move beyond simply seeking cost reductions.http://link.springer.com/article/10.1186/s12913-019-4620-1Homeless personPatient readmissionHealth services researchCost savingsInclusion healthPathway |
| spellingShingle | Hannah Field Briony Hudson Nigel Hewett Zana Khan Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation BMC Health Services Research Homeless person Patient readmission Health services research Cost savings Inclusion health Pathway |
| title | Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation |
| title_full | Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation |
| title_fullStr | Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation |
| title_full_unstemmed | Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation |
| title_short | Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation |
| title_sort | secondary care usage and characteristics of hospital inpatients referred to a uk homeless health team a retrospective service evaluation |
| topic | Homeless person Patient readmission Health services research Cost savings Inclusion health Pathway |
| url | http://link.springer.com/article/10.1186/s12913-019-4620-1 |
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