Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons

Abstract

Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.

KEYWORDS:

• discharge planning
• health services
• homeless
• readmission
• retrospective studies

This report is dedicated to the memories of Nurse Barbara McInnis of Pine Street Inn and Ms. Ellen Dailey, whose longstanding advocacy on behalf of Boston's homeless spurred the development of novel models of service to this population. The authors acknowledge the kind assistance of Mr. Walter Ferranti of Boston Medical Center, and Teresa Everson in the conduct of this study. The Lister Hill Center on Health Policy (University of Alabama at Birmingham), the National Institute on Drug Abuse (K23-DA-15487), and Boston Health Care for the Homeless Program supported this work. These entities had no role in the collection, analysis, or interpretation of the data or in the decision to submit the manuscript for publication. Professor Ash is associated with the company that licenses the software to implement Diagnostic Cost Group (DCG)–based casemix adjustment (Versick Health, lnc.).

Notes

Note: Italicized comparisons are significant at p < .05.

^a Percentages do not consistently add to 100% due to rounding.

^b p-values reflect a 3-group comparison (Respite versus Own Care versus Other Planned Care) by Chi-squared test or analysis of variance (df = 2), with α = 0.05, 2-tailed.

^c Illness burden computed with the Diagnostic Cost Group (DCG) prospective relative risk score based on diagnoses recorded during 180 days previous to, and during, the index admission. Low, medium, and high risk indicate DCG relative risk scores of <0.5, 0.5–1.5, and >1.5, respectively.

^d Alcohol and drug abuse are based on administratively coded (ICD-9) diagnoses from the index hospitalization and the prior 6 months of care at that hospital (Boston Medical Center).

^e Computation of percentage readmitted excludes 8 of 743 patients who died during the 90-day follow-up interval (2 Respite, 3 Own Care, and 3 Other Care).

Note: Propensity scores were developed by applying all displayed variables in a single logistic regression model predicting discharge location. Propensity score-weighted groups combine data available for all Respite and Own Care subjects, applying a weight of 1/(propensity score) for each Respite observation and 1/(1-propensity score) for each Own Care observation (Hirano et al., 2001). Italicized comparisons are significant at the p < .05 level, 2-tailed, applying Chi-squared and t-tests, as appropriate (all df = 1).

Note: Results for a single multivariable logistic regression are shown, adjusted for all variables displayed, using propensity score-weighted data to minimize heterogeneity between the Respite versus Own Care disposition groups; italicized comparisons are significant at p < .05.