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Homeless Status, Postdischarge Health Care Utilization, and Readmission After Surgery
- Source :
- Medical Care. 56:460-469
- Publication Year :
- 2018
- Publisher :
- Ovid Technologies (Wolters Kluwer Health), 2018.
-
Abstract
- Homeless Veterans are vulnerable to poor care transitions, yet little research has examined their risk of readmission following inpatient surgery. This study investigates the predictors of surgical readmission among homeless relative to housed Veteran patients.Inpatient general, vascular, and orthopedic surgeries occurring in the Veterans Health Administration from 2008 to 2014 were identified. Administrative International Classification of Diseases, Ninth Revision, Clinical Modification codes and Veterans Health Administration clinic stops were used to identify homeless patients. Bivariate analyses examined characteristics and predictors of readmission among homeless patients. Multivariate logistic models were used to estimate the association between homeless experience and housed patients with readmission following surgery.Our study included 232,373 surgeries: 43% orthopedic, 39% general, and 18% vascular with 5068 performed on homeless patients. Homeless individuals were younger (56 vs. 64 y, P0.01), more likely to have a psychiatric comorbidities (51.3% vs. 19.4%, P0.01) and less likely to have other medical comorbidities such as hypertension (57.1% vs. 70.8%, P0.01). Homeless individuals were more likely to be readmitted [odds ratio (OR), 1.43; confidence interval (CI), 1.30-1.56; P0.001]. Discharge destination other than community (OR, 0.57; CI, 0.44-0.74; P0.001), recent alcohol abuse (OR, 1.45; CI, 1.15-1.84; P0.01), and elevated American Society Anesthesiologists classification (OR, 1.86; CI, 1.30-2.68; P0.01) were significant risk factors associated with readmissions within the homeless cohort.Readmissions are higher in homeless individuals discharged to the community after surgery. Judicious use of postoperative nursing or residential rehabilitation programs may be effective in reducing readmission and improving care transitions among these vulnerable Veterans. Relative costs and benefits of alternatives to community discharge merit investigation.
- Subjects :
- Adult
Male
medicine.medical_specialty
MEDLINE
Patient Readmission
03 medical and health sciences
Postoperative Complications
0302 clinical medicine
Residence Characteristics
Risk Factors
Health care
Humans
Medicine
030212 general & internal medicine
Poverty
health care economics and organizations
Care Transitions
Veterans
030505 public health
business.industry
Public Health, Environmental and Occupational Health
Middle Aged
Surgical procedures
Patient Discharge
United States
humanities
Surgery
Surgical Procedures, Operative
Ill-Housed Persons
Female
0305 other medical science
business
Subjects
Details
- ISSN :
- 00257079
- Volume :
- 56
- Database :
- OpenAIRE
- Journal :
- Medical Care
- Accession number :
- edsair.doi.dedup.....2784cda4bd29b8451aff51cfcb19b23b