Skip to main content
Top
Published in: BMC Health Services Research 1/2014

Open Access 01-12-2014 | Research article

Preventable hospital admissions among the homeless in California: A retrospective analysis of care for ambulatory care sensitive conditions

Authors: Brandi M White, Charles Ellis Jr, Kit N Simpson

Published in: BMC Health Services Research | Issue 1/2014

Login to get access

Abstract

Background

Limited research exists that investigates hospital admissions for ambulatory care sensitive conditions (ACSCs) among the homeless, who frequently lack a usual source of care. This study profiled ACSC admissions for homeless patients.

Methods

Bivariate analyses and logistic regression were completed to investigate ACSC and non-ACSC admissions among homeless patients using the 2010 California State Inpatient Database.

Results

Homeless patients admitted for an ACSC were mostly male, non-Hispanic white, and on average 49.9 years old. In the predictive model, the odds of an ACSC admission among homeless patients increased when they were black, admitted to the emergency department or transferred from another health facility. Having Medicare was associated with a decreased odds of an ACSC admission.

Conclusions

Specific characteristics are associated with a greater likelihood of an ACSC admission. Research should examine how these characteristics contribute to ACSC hospitalizations and findings should be linked to programs designed to serve as a safety-net for homeless patients to reduce hospitalizations.
Literature
1.
go back to reference Burt MR, Aron LY, Lee E, Valent J: How many homeless people are there?: Helping America’s Homeless: Emergency Shelter or Affordable Housing?. 2001, Urban Institute, Washington, DC Burt MR, Aron LY, Lee E, Valent J: How many homeless people are there?: Helping America’s Homeless: Emergency Shelter or Affordable Housing?. 2001, Urban Institute, Washington, DC
2.
go back to reference Wright NM, Tompkins CN: How can health services effectively meet the health needs of homeless people?. Br J Gen Pract. 2006, 56 (525): 286-93.PubMedPubMedCentral Wright NM, Tompkins CN: How can health services effectively meet the health needs of homeless people?. Br J Gen Pract. 2006, 56 (525): 286-93.PubMedPubMedCentral
3.
go back to reference Kushel MB, Vittinghoff E, Haas JS: Factors associated with the health care utilization of homeless persons. JAMA. 2001, 285 (2): 200-206. 10.1001/jama.285.2.200.CrossRefPubMed Kushel MB, Vittinghoff E, Haas JS: Factors associated with the health care utilization of homeless persons. JAMA. 2001, 285 (2): 200-206. 10.1001/jama.285.2.200.CrossRefPubMed
4.
go back to reference Hwang SW, Orav EJ, O’Connell JJ, Lebow JM, Brennan TA: Causes of death in homeless adults in Boston. Ann Intern Med. 1997, 126 (8): 625-8. 10.7326/0003-4819-126-8-199704150-00007.CrossRefPubMed Hwang SW, Orav EJ, O’Connell JJ, Lebow JM, Brennan TA: Causes of death in homeless adults in Boston. Ann Intern Med. 1997, 126 (8): 625-8. 10.7326/0003-4819-126-8-199704150-00007.CrossRefPubMed
5.
go back to reference AHRQ Quality Indicators-Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. 2001, Pub. No. 02-R0203, AHRQ, Rockville, MD AHRQ Quality Indicators-Guide to Prevention Quality Indicators: Hospital Admission for Ambulatory Care Sensitive Conditions. 2001, Pub. No. 02-R0203, AHRQ, Rockville, MD
6.
go back to reference Ansari Z, Haider SI, Ansari H, De Gooyer T, Sindall C: Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia. BMC Health Serv Res. 2012, 12: 475-10.1186/1472-6963-12-475.CrossRefPubMedPubMedCentral Ansari Z, Haider SI, Ansari H, De Gooyer T, Sindall C: Patient characteristics associated with hospitalisations for ambulatory care sensitive conditions in Victoria, Australia. BMC Health Serv Res. 2012, 12: 475-10.1186/1472-6963-12-475.CrossRefPubMedPubMedCentral
7.
go back to reference Falik M, Needleman J, Wells BL, Korb J: Ambulatory care sensitive hospitalizations and emergency visits: Experiences of Medicaid patients using federally qualified health centers. Med Care. 2001, 39 (6): 551-561. 10.1097/00005650-200106000-00004.CrossRefPubMed Falik M, Needleman J, Wells BL, Korb J: Ambulatory care sensitive hospitalizations and emergency visits: Experiences of Medicaid patients using federally qualified health centers. Med Care. 2001, 39 (6): 551-561. 10.1097/00005650-200106000-00004.CrossRefPubMed
8.
go back to reference Adams J, Rosenheck R, Gee L, Seibyl CL, Kushel M: Hospitalized younger: A comparison of a national sample of homeless and housed inpatient veterans. J Health Care Poor Underserved. 2007, 18 (1): 173-184. 10.1353/hpu.2007.0000.CrossRefPubMed Adams J, Rosenheck R, Gee L, Seibyl CL, Kushel M: Hospitalized younger: A comparison of a national sample of homeless and housed inpatient veterans. J Health Care Poor Underserved. 2007, 18 (1): 173-184. 10.1353/hpu.2007.0000.CrossRefPubMed
9.
go back to reference Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL: Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998, 338 (24): 1734-1740. 10.1056/NEJM199806113382406.CrossRefPubMed Salit SA, Kuhn EM, Hartz AJ, Vu JM, Mosso AL: Hospitalization costs associated with homelessness in New York City. N Engl J Med. 1998, 338 (24): 1734-1740. 10.1056/NEJM199806113382406.CrossRefPubMed
11.
go back to reference Purdy S, Griffin T, Salisbury C, Sharp D: Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health. 2009, 123 (2): 169-173. 10.1016/j.puhe.2008.11.001.CrossRefPubMed Purdy S, Griffin T, Salisbury C, Sharp D: Ambulatory care sensitive conditions: terminology and disease coding need to be more specific to aid policy makers and clinicians. Public Health. 2009, 123 (2): 169-173. 10.1016/j.puhe.2008.11.001.CrossRefPubMed
12.
go back to reference Wolff JL, Starfield B, Anderson G: Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002, 162 (20): 2269-2276. 10.1001/archinte.162.20.2269.CrossRefPubMed Wolff JL, Starfield B, Anderson G: Prevalence, expenditures, and complications of multiple chronic conditions in the elderly. Arch Intern Med. 2002, 162 (20): 2269-2276. 10.1001/archinte.162.20.2269.CrossRefPubMed
13.
go back to reference Burr J, Sherman G, Prentice D, Hill C, Fraser V, Kollef MH: Ambulatory care-sensitive conditions: Clinical outcomes and impact on intensive care unit resource use. South Med J. 2003, 96 (2): 172-178. 10.1097/01.SMJ.0000050680.55019.32.CrossRefPubMed Burr J, Sherman G, Prentice D, Hill C, Fraser V, Kollef MH: Ambulatory care-sensitive conditions: Clinical outcomes and impact on intensive care unit resource use. South Med J. 2003, 96 (2): 172-178. 10.1097/01.SMJ.0000050680.55019.32.CrossRefPubMed
14.
go back to reference Johnson PJ, Ghildayal N, Ward AC, Westgard BC, Boland LL, Hokanson JS: Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions. Med Care. 2012, 50 (12): 1020-1028. 10.1097/MLR.0b013e318270bad4.CrossRefPubMed Johnson PJ, Ghildayal N, Ward AC, Westgard BC, Boland LL, Hokanson JS: Disparities in potentially avoidable emergency department (ED) care: ED visits for ambulatory care sensitive conditions. Med Care. 2012, 50 (12): 1020-1028. 10.1097/MLR.0b013e318270bad4.CrossRefPubMed
15.
go back to reference Mayberry RM, Mili F, Ofili E: Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000, 57 (Suppl 1): 108-145. 10.1177/1077558700574006.CrossRefPubMed Mayberry RM, Mili F, Ofili E: Racial and ethnic differences in access to medical care. Med Care Res Rev. 2000, 57 (Suppl 1): 108-145. 10.1177/1077558700574006.CrossRefPubMed
16.
go back to reference Gaskin DJ, Hoffman C: Racial and ethnic differences in preventable hospitalizations across 10 states. Med Care Res Rev. 2000, 57 (Suppl 1): 85-107. 10.1177/107755800773743619.CrossRefPubMed Gaskin DJ, Hoffman C: Racial and ethnic differences in preventable hospitalizations across 10 states. Med Care Res Rev. 2000, 57 (Suppl 1): 85-107. 10.1177/107755800773743619.CrossRefPubMed
17.
go back to reference Sambamoorthi U, McAlpine DD: Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med. 2003, 37 (5): 475-484. 10.1016/S0091-7435(03)00172-5.CrossRefPubMed Sambamoorthi U, McAlpine DD: Racial, ethnic, socioeconomic, and access disparities in the use of preventive services among women. Prev Med. 2003, 37 (5): 475-484. 10.1016/S0091-7435(03)00172-5.CrossRefPubMed
18.
go back to reference Howard DL, Hakeem FB, Njue C, Carey T, Jallah Y: Racially disproportionate admission rates for ambulatory care sensitive conditions in North Carolina. Public Health Rep. 2007, 122 (3): 362-372.PubMedPubMedCentral Howard DL, Hakeem FB, Njue C, Carey T, Jallah Y: Racially disproportionate admission rates for ambulatory care sensitive conditions in North Carolina. Public Health Rep. 2007, 122 (3): 362-372.PubMedPubMedCentral
19.
go back to reference Hwang SW, Bugeja AL: Barriers to appropriate diabetes management among homeless people in Toronto. CMAJ. 2000, 163 (2): 161-165.PubMedPubMedCentral Hwang SW, Bugeja AL: Barriers to appropriate diabetes management among homeless people in Toronto. CMAJ. 2000, 163 (2): 161-165.PubMedPubMedCentral
20.
go back to reference Chang CF, Troyer JL: Trends in potentially avoidable hospitalizations among adults in Tennessee, 1998-2006. Tenn Med. 2011, 104 (10): 35-8.PubMed Chang CF, Troyer JL: Trends in potentially avoidable hospitalizations among adults in Tennessee, 1998-2006. Tenn Med. 2011, 104 (10): 35-8.PubMed
21.
go back to reference Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R: Trends and characteristics of US emergency department visits, 1997-2007. JAMA. 2010, 304 (6): 664-670. 10.1001/jama.2010.1112.CrossRefPubMedPubMedCentral Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R: Trends and characteristics of US emergency department visits, 1997-2007. JAMA. 2010, 304 (6): 664-670. 10.1001/jama.2010.1112.CrossRefPubMedPubMedCentral
22.
go back to reference Caldwell N, Srebotnjak T, Wang T, Hsia R: ‘How Much Will I Get Charged for This?’ Patient Charges for Top Ten Diagnoses in the Emergency Department. PLoS One. 2013, 8 (2): e55491-10.1371/journal.pone.0055491.CrossRefPubMedPubMedCentral Caldwell N, Srebotnjak T, Wang T, Hsia R: ‘How Much Will I Get Charged for This?’ Patient Charges for Top Ten Diagnoses in the Emergency Department. PLoS One. 2013, 8 (2): e55491-10.1371/journal.pone.0055491.CrossRefPubMedPubMedCentral
23.
go back to reference Karaca Z, Wong H, Mutter R: Characteristics of Homeless and Non-Homeless Individuals Using Inpatient and Emergency Department Services, 2008. 2013, Statistical Brief #152, Agency for Healthcare Research and Quality, Rockville, MD Karaca Z, Wong H, Mutter R: Characteristics of Homeless and Non-Homeless Individuals Using Inpatient and Emergency Department Services, 2008. 2013, Statistical Brief #152, Agency for Healthcare Research and Quality, Rockville, MD
24.
go back to reference Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR: Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002, 92 (5): 778-784. 10.2105/AJPH.92.5.778.CrossRefPubMedPubMedCentral Kushel MB, Perry S, Bangsberg D, Clark R, Moss AR: Emergency department use among the homeless and marginally housed: results from a community-based study. Am J Public Health. 2002, 92 (5): 778-784. 10.2105/AJPH.92.5.778.CrossRefPubMedPubMedCentral
25.
go back to reference D’Amore J, Hung O, Chiang W, Goldfrank L: The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med. 2001, 8 (11): 1051-1055. 10.1111/j.1553-2712.2001.tb01114.x.CrossRefPubMed D’Amore J, Hung O, Chiang W, Goldfrank L: The epidemiology of the homeless population and its impact on an urban emergency department. Acad Emerg Med. 2001, 8 (11): 1051-1055. 10.1111/j.1553-2712.2001.tb01114.x.CrossRefPubMed
26.
go back to reference Gallagher TC, Andersen RM, Koegel P, Gelberg L: Determinants of regular source of care among homeless adults in Los Angeles. Med Care. 1997, 35 (8): 814-830. 10.1097/00005650-199708000-00007.CrossRefPubMed Gallagher TC, Andersen RM, Koegel P, Gelberg L: Determinants of regular source of care among homeless adults in Los Angeles. Med Care. 1997, 35 (8): 814-830. 10.1097/00005650-199708000-00007.CrossRefPubMed
27.
go back to reference Stein JA, Andersen RM, Koegel P, Gelberg L: Predicting health services utilization among homeless adults: a prospective analysis. J Health Care Poor Underserved. 2000, 11 (2): 212-230. 10.1353/hpu.2010.0675.CrossRefPubMed Stein JA, Andersen RM, Koegel P, Gelberg L: Predicting health services utilization among homeless adults: a prospective analysis. J Health Care Poor Underserved. 2000, 11 (2): 212-230. 10.1353/hpu.2010.0675.CrossRefPubMed
28.
go back to reference Health Centers: America’s Primary Care Safety Net, Reflections on Success, 2002-2007. 2008, U.S. Department of Health and Human Services, Rockville, MD Health Centers: America’s Primary Care Safety Net, Reflections on Success, 2002-2007. 2008, U.S. Department of Health and Human Services, Rockville, MD
29.
go back to reference Lebrun-Harris LA, Baggett TP, Jenkins DM, Sripipatana A, Sharma R, Hayashi AS, Daly CA, Ngo-Metzger Q: Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey. Health Serv Res. 2013, 48 (3): 992-1017. 10.1111/1475-6773.12009.CrossRefPubMed Lebrun-Harris LA, Baggett TP, Jenkins DM, Sripipatana A, Sharma R, Hayashi AS, Daly CA, Ngo-Metzger Q: Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2009 Patient Survey. Health Serv Res. 2013, 48 (3): 992-1017. 10.1111/1475-6773.12009.CrossRefPubMed
30.
go back to reference Tsai J, Rosenheck RA, Culhane DP, Artiga S: Medicaid expansion: Chronically homeless adults will need targeted enrollment and access to a broad range of services. Health Aff (Millwood). 2013, 32 (9): 1552-1559. 10.1377/hlthaff.2013.0228.CrossRef Tsai J, Rosenheck RA, Culhane DP, Artiga S: Medicaid expansion: Chronically homeless adults will need targeted enrollment and access to a broad range of services. Health Aff (Millwood). 2013, 32 (9): 1552-1559. 10.1377/hlthaff.2013.0228.CrossRef
Metadata
Title
Preventable hospital admissions among the homeless in California: A retrospective analysis of care for ambulatory care sensitive conditions
Authors
Brandi M White
Charles Ellis Jr
Kit N Simpson
Publication date
01-12-2014
Publisher
BioMed Central
Published in
BMC Health Services Research / Issue 1/2014
Electronic ISSN: 1472-6963
DOI
https://doi.org/10.1186/s12913-014-0511-7

Other articles of this Issue 1/2014

BMC Health Services Research 1/2014 Go to the issue