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Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation

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 ass...

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Autores principales: Field, Hannah, Hudson, Briony, Hewett, Nigel, Khan, Zana
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868755/
https://www.ncbi.nlm.nih.gov/pubmed/31752857
http://dx.doi.org/10.1186/s12913-019-4620-1
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author Field, Hannah
Hudson, Briony
Hewett, Nigel
Khan, Zana
author_facet Field, Hannah
Hudson, Briony
Hewett, Nigel
Khan, Zana
author_sort Field, Hannah
collection PubMed
description 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.
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spelling pubmed-68687552019-12-12 Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation Field, Hannah Hudson, Briony Hewett, Nigel Khan, Zana BMC Health Serv Res Research Article 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. BioMed Central 2019-11-21 /pmc/articles/PMC6868755/ /pubmed/31752857 http://dx.doi.org/10.1186/s12913-019-4620-1 Text en © The Author(s). 2019 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Field, Hannah
Hudson, Briony
Hewett, Nigel
Khan, Zana
Secondary care usage and characteristics of hospital inpatients referred to a UK homeless health team: a retrospective service evaluation
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 Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6868755/
https://www.ncbi.nlm.nih.gov/pubmed/31752857
http://dx.doi.org/10.1186/s12913-019-4620-1
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