Skip to main content
Top
Published in:

Open Access 01-12-2023 | Care | Research

Reducing hospital readmissions amongst people experiencing homelessness: a mixed-methods evaluation of a multi-disciplinary hospital in-reach programme

Authors: Stephen Malden, Lawrence Doi, Lauren Ng, Fiona Cuthill

Published in: BMC Public Health | Issue 1/2023

Login to get access

Abstract

Introduction

People experiencing homelessness are at increased risk of experiencing ill-health. They are often readmitted to hospital after discharge, usually for the same or similar reasons for initial hospitalisation. One way of addressing this issue is through hospital in-reach initiatives, which have been established to enhance the treatment and discharge pathways that patients identified as homeless receive after hospital admission. Since 2020, the Hospital In-reach programme (which involves targeted clinical interventions and structured discharge support) has been piloted in two large National Health Service (NHS) hospitals in Edinburgh, United Kingdom (UK). This study describes an evaluation of the programme.

Methods

This evaluation used a mixed method, pre-post design. To assess the effect of the programme on hospital readmission rates from baseline (12 months pre-intervention) and follow-up (12 months post-intervention), aggregate data describing the proportions of homeless-affected individuals admitted to hospital during the evaluation period were analysed using Wilcoxon signed rank test, with level of significance set at p = 0.05. Qualitative interviews were conducted with fifteen programme and hospital staff (nurses, general practitioners, homeless link workers) to assess the processes of the programme.

Results

A total of 768 referrals, including readmissions, were made to the In-reach programme during the study period, of which eighty–eight individuals were followed up as part of the study. In comparison to admissions in the previous 12 months, readmissions were significantly reduced at 12 months follow-up by 68.7% (P = 0.001) for those who received an in-reach intervention of any kind. Qualitative findings showed that the programme was valued by hospital staff and homeless community workers. Housing services and clinical staff attributed improvements in services to their ability to collaborate more effectively in secondary care settings. This ensured treatment regimens were completed and housing was retained during hospital admission, which facilitated earlier discharge planning.

Conclusions

A multidisciplinary approach to reducing readmissions in people experiencing homelessness was effective at reducing readmissions over a 12-month period. The programme appears to have enhanced the ability for multiple agencies to work more closely and ensure the appropriate care is provided for those at risk of readmission to hospital among people affected by homelessness.
Appendix
Available only for authorised users
Literature
1.
go back to reference Baggett TP, Chang Y, Porneala BC, Bharel M, Singer DE, Rigotti NAJAjopm. Disparities in cancer incidence, stage, and mortality at Boston Health Care for the Homeless Program. 2015;49(5):694–702. Baggett TP, Chang Y, Porneala BC, Bharel M, Singer DE, Rigotti NAJAjopm. Disparities in cancer incidence, stage, and mortality at Boston Health Care for the Homeless Program. 2015;49(5):694–702.
2.
go back to reference Baggett TP, Liauw SS, Hwang SWJJotACoC. Cardiovasc disease homelessness. 2018;71(22):2585–97. Baggett TP, Liauw SS, Hwang SWJJotACoC. Cardiovasc disease homelessness. 2018;71(22):2585–97.
3.
go back to reference Burki TKJTLRM. Homelessness and respiratory disease. 2013;1(10):767–8. Burki TKJTLRM. Homelessness and respiratory disease. 2013;1(10):767–8.
4.
go back to reference Liu C, Chai S, Watt JJE. Infection. Communicable disease among people experiencing homelessness in California. 2020;148. Liu C, Chai S, Watt JJE. Infection. Communicable disease among people experiencing homelessness in California. 2020;148.
5.
go back to reference Morrison DSJIjoe. Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. 2009;38(3):877–83. Morrison DSJIjoe. Homelessness as an independent risk factor for mortality: results from a retrospective cohort study. 2009;38(3):877–83.
6.
go back to reference Patterson ML, Somers JM, Moniruzzaman AJMH, Use S. Prolonged and persistent homelessness: multivariable analyses in a cohort experiencing current homelessness and mental illness in Vancouver. Br Columbia. 2012;5(2):85–101. Patterson ML, Somers JM, Moniruzzaman AJMH, Use S. Prolonged and persistent homelessness: multivariable analyses in a cohort experiencing current homelessness and mental illness in Vancouver. Br Columbia. 2012;5(2):85–101.
7.
go back to reference Morrison DS. Homelessness and deprivation in Glasgow: a 5-year retrospective cohort study of hospitalisations and deaths. University of Glasgow; 2008. Morrison DS. Homelessness and deprivation in Glasgow: a 5-year retrospective cohort study of hospitalisations and deaths. University of Glasgow; 2008.
8.
go back to reference Trick WE, Rachman F, Hinami K, Hill JC, Conover C, Diep L et al. Variability in comorbidites and health services use across homeless typologies: multicenter data linkage between healthcare and homeless systems. 2021;21(1):1–9. Trick WE, Rachman F, Hinami K, Hill JC, Conover C, Diep L et al. Variability in comorbidites and health services use across homeless typologies: multicenter data linkage between healthcare and homeless systems. 2021;21(1):1–9.
9.
go back to reference Hewett N, Halligan A, Boyce TJB. A general practitioner and nurse led approach to improving hospital care for homeless people. 2012;345. Hewett N, Halligan A, Boyce TJB. A general practitioner and nurse led approach to improving hospital care for homeless people. 2012;345.
10.
go back to reference Lewer D, Menezes D, Cornes M, Blackburn R, Byng R, Clark M et al. Hospital readmissions among people experiencing homelessness: a cohort study of linked hospitalisation and mortality data in England for 3,222 homeless inpatients. 2019. Lewer D, Menezes D, Cornes M, Blackburn R, Byng R, Clark M et al. Hospital readmissions among people experiencing homelessness: a cohort study of linked hospitalisation and mortality data in England for 3,222 homeless inpatients. 2019.
11.
go back to reference Weinreb L, Goldberg R, Perloff JJJogim. Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers. 1998;13(6):389–97. Weinreb L, Goldberg R, Perloff JJJogim. Health characteristics and medical service use patterns of sheltered homeless and low-income housed mothers. 1998;13(6):389–97.
12.
go back to reference Hewett N, Buchman P, Musariri J, Sargeant C, Johnson P, Abeysekera K et al. Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’). 2016;16(3):223. Hewett N, Buchman P, Musariri J, Sargeant C, Johnson P, Abeysekera K et al. Randomised controlled trial of GP-led in-hospital management of homeless people (‘Pathway’). 2016;16(3):223.
13.
go back to reference Wyatt LJBJoHM. Positive outcomes for homeless patients in UCLH Pathway programme. 2017;23(8):367–71. Wyatt LJBJoHM. Positive outcomes for homeless patients in UCLH Pathway programme. 2017;23(8):367–71.
14.
go back to reference Baxter AJ, Tweed EJ, Katikireddi SV, Thomson HJJECH. Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. 2019;73(5):379–87. Baxter AJ, Tweed EJ, Katikireddi SV, Thomson HJJECH. Effects of Housing First approaches on health and well-being of adults who are homeless or at risk of homelessness: systematic review and meta-analysis of randomised controlled trials. 2019;73(5):379–87.
15.
go back to reference Terry G, Hayfield N, Clarke V, Braun VJTShoqrip. Thematic Anal. 2017;2:17–37. Terry G, Hayfield N, Clarke V, Braun VJTShoqrip. Thematic Anal. 2017;2:17–37.
16.
go back to reference Dorney-Smith S, Hewett N, Khan Z, Smith RJBJoHM. Integrating health care for homeless people: experiences of the KHP pathway homeless team. 2016;22(4):215–24. Dorney-Smith S, Hewett N, Khan Z, Smith RJBJoHM. Integrating health care for homeless people: experiences of the KHP pathway homeless team. 2016;22(4):215–24.
Metadata
Title
Reducing hospital readmissions amongst people experiencing homelessness: a mixed-methods evaluation of a multi-disciplinary hospital in-reach programme
Authors
Stephen Malden
Lawrence Doi
Lauren Ng
Fiona Cuthill
Publication date
01-12-2023
Publisher
BioMed Central
Keyword
Care
Published in
BMC Public Health / Issue 1/2023
Electronic ISSN: 1471-2458
DOI
https://doi.org/10.1186/s12889-023-16048-1

Other articles of this Issue 1/2023

BMC Public Health 1/2023 Go to the issue