Dedicated homeless clinics reduce inappropriate emergency department utilization
Abstract Background The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to deter...
| Main Authors: | , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2020-10-01
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| Series: | Journal of the American College of Emergency Physicians Open |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/emp2.12054 |
| _version_ | 1826574641508909056 |
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| author | Chad T. Holmes Katherine A. Holmes Andrew MacDonald Frank R. Lonergan Joel J. Hunt Sajid Shaikh Radhika Cheeti James P. D'Etienne Nestor R. Zenarosa Hao Wang |
| author_facet | Chad T. Holmes Katherine A. Holmes Andrew MacDonald Frank R. Lonergan Joel J. Hunt Sajid Shaikh Radhika Cheeti James P. D'Etienne Nestor R. Zenarosa Hao Wang |
| author_sort | Chad T. Holmes |
| collection | DOAJ |
| description | Abstract Background The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients. Methods We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization. Results A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty‐nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate (P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50–0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression. Conclusion Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness. |
| first_indexed | 2024-12-12T08:51:07Z |
| format | Article |
| id | doaj.art-4dd4b61688f34d5d93888d8b0d8a46d2 |
| institution | Directory Open Access Journal |
| issn | 2688-1152 |
| language | English |
| last_indexed | 2025-03-14T13:02:02Z |
| publishDate | 2020-10-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of the American College of Emergency Physicians Open |
| spelling | doaj.art-4dd4b61688f34d5d93888d8b0d8a46d22025-03-02T03:04:27ZengElsevierJournal of the American College of Emergency Physicians Open2688-11522020-10-011582983610.1002/emp2.12054Dedicated homeless clinics reduce inappropriate emergency department utilizationChad T. Holmes0Katherine A. Holmes1Andrew MacDonald2Frank R. Lonergan3Joel J. Hunt4Sajid Shaikh5Radhika Cheeti6James P. D'Etienne7Nestor R. Zenarosa8Hao Wang9Department of Emergency Medicine John Peter Smith Health Network Fort Worth TexasDepartment of Emergency Medicine John Peter Smith Health Network Fort Worth TexasDepartment of Emergency Medicine John Peter Smith Health Network Fort Worth TexasDepartment of Family Medicine John Peter Smith Health Network Fort Worth TexasDepartment of Family Medicine John Peter Smith Health Network Fort Worth TexasDepartment of Information Technology John Peter Smith Health Network Fort Worth TexasDepartment of Information Technology John Peter Smith Health Network Fort Worth TexasDepartment of Emergency Medicine John Peter Smith Health Network Fort Worth TexasDepartment of Emergency Medicine John Peter Smith Health Network Fort Worth TexasDepartment of Emergency Medicine John Peter Smith Health Network Fort Worth TexasAbstract Background The homeless patient population is known to have a high occurrence of inappropriate emergency department (ED) utilization. The study hospital initiated a dedicated homeless clinic targeting patients experiencing homelessness with a combination of special features. We aim to determine whether this mode of care can reduce inappropriate ED utilization among homeless patients. Methods We conducted a retrospective observational study from July 1, 2017 to Dec 31, 2017. The study enrolled all homeless patients who visited any hospital regular clinic, dedicated homeless clinic, and ED at least once during the study period. ED homeless patients were divided into four groups (A: no clinic visits; B: those who only visited hospital regular clinic; C: those who only visited dedicated homeless clinic; and D: those who visited both hospital regular clinic and dedicated homeless clinic). The New York University algorithm was used to determine appropriate ED utilization. We compared inappropriate ED utilization among patients from these groups. Multivariate logistic regression was used to determine the risks of different clinical visits in association with inappropriate ED utilization. Results A total of 16,323 clinic and 8511 ED visits occurred among 5022 unique homeless patients, in which 2450 unique patients were seen in hospital regular clinic, 784 patients in dedicated homeless clinic, 688 patients in both hospital regular clinic and dedicated homeless clinic, and 1110 patients with no clinic visits. Twenty‐nine percent (230/784) of patients from dedicated homeless clinic utilized the ED, among which 21% (175/844) of their ED visits were considered inappropriate. In contrast, 40% of patients from hospital regular clinic utilized the ED, among which 29% were inappropriate (P < 0.001). The adjusted odds ratio (OR) was 0.61 (95% confidence interval [CI] = 0.50–0.74, P < 0.001) on dedicated homeless clinic predicting inappropriate ED visits in multivariate logistic regression. Conclusion Implementing a dedicated homeless clinic with these features can reduce ED inappropriate utilization among patients experiencing homelessness.https://doi.org/10.1002/emp2.12054clinicsemergency departmenthomelessinappropriate utilization |
| spellingShingle | Chad T. Holmes Katherine A. Holmes Andrew MacDonald Frank R. Lonergan Joel J. Hunt Sajid Shaikh Radhika Cheeti James P. D'Etienne Nestor R. Zenarosa Hao Wang Dedicated homeless clinics reduce inappropriate emergency department utilization Journal of the American College of Emergency Physicians Open clinics emergency department homeless inappropriate utilization |
| title | Dedicated homeless clinics reduce inappropriate emergency department utilization |
| title_full | Dedicated homeless clinics reduce inappropriate emergency department utilization |
| title_fullStr | Dedicated homeless clinics reduce inappropriate emergency department utilization |
| title_full_unstemmed | Dedicated homeless clinics reduce inappropriate emergency department utilization |
| title_short | Dedicated homeless clinics reduce inappropriate emergency department utilization |
| title_sort | dedicated homeless clinics reduce inappropriate emergency department utilization |
| topic | clinics emergency department homeless inappropriate utilization |
| url | https://doi.org/10.1002/emp2.12054 |
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