Accuracy of self-reported healthcare use in a population-based sample of homeless adults

Objective — To assess the accuracy of self-reported ambulatory care visits, emergency department (ED) encounters, and overnight hospitalizations in a population-based sample of homeless adults.

Data Source — Self-report survey data and administrative healthcare utilization databases.

Study Design — Self-reported healthcare use in the past 12 months was compared to administrative encounter records among 1,163 homeless adults recruited in 2004–2005 from shelters and meal programs in Toronto, Ontario.

Data Extraction Methods — Self-reported healthcare use was assessed using a structured face-to-face survey. Each participant was linked to administrative databases using a unique personal health number or their first name, last name, sex, and date of birth.

Principal Findings — The sensitivity of self-report for ambulatory care visits, ED encounters, and overnight hospitalizations was 89, 80, and 73 percent, respectively; specificity was 37, 83, and 91 percent. The mean difference between self-reported and documented number of encounters in the past 12 months was +1.6 for ambulatory care visits (95 percent CI = 0.4, 2.8), −0.6 for ED encounters (95 percent CI = −0.8, −0.4), and 0.0 for hospitalizations (95 percent CI = 0.0, 0.1).

Conclusions — Adults experiencing homelessness are quite accurate reporters of their use of healthcare, especially for ED encounters and hospitalizations.