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Hospital readmissions in a community-based sample of homeless adults: a matched-cohort study


Background — Hospital readmission rates are a widely used quality indicator that may be elevated in disadvantaged populations.

Objective — The objective of this study was to compare the hospital readmission rate among individuals experiencing homelessness with that of a low-income matched control group, and to identify risk factors associated with readmission within the group experiencing homelessness.

Design — We conducted a 1:1 matched cohort study comparing 30-day hospital readmission rates between homeless patients and low-income controls matched on age, sex and primary reason for admission. Multivariate analyses using generalized estimating equations were used to assess risk factors associated with 30-day readmission in the homeless cohort.

Participants — This study examined a cohort of 1,165 homeless adults recruited at homeless shelters and meal programs in Toronto, Ontario, between December 6, 2004, and December 20, 2005.

Main Measures — The primary outcome was the occurrence of an unplanned medical or surgical readmission within 30 days of discharge from hospital.

Key Results — Between December 6th, 2004 and March 31st, 2009, homeless participants (N= 203) had 478 hospitalizations and a 30-day readmission rate of 22.2%, compared to 300 hospitalizations and a readmission rate of 7.0% among matched controls (OR= 3.79, 95% CI 1.93-7.39). In the homeless cohort, having a primary care physician (OR=2.65, 95% CI 1.05-6.73) and leaving against medical advice (OR=1.96, 95% CI 0.99-3.86) were associated with an increased risk of 30-day readmission.

Conclusions — Homeless patients had nearly four times the odds of being readmitted within 30-days as compared to low-income controls matched on age, sex and primary reason for admission to hospital. Further research is needed to evaluate interventions to reduce readmissions among this patient population.



Saab D, Nisenbaum R, Dhalla I, Hwang SW. J Gen Intern Med. 2016; 31(9):1011-8. Epub 2016 May 19.

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