April 17, 2009

• Homeless half as likely to be readmitted to hospital

• Supports smaller 2006 study

BIRMINGHAM, Ala. - Medical respite programs that offer medical, nursing and other care, as well as accommodations, for homeless persons discharged from acute hospital stays significantly reduce the likelihood a person will be readmitted to the hospital within 90 days, according to a University of Alabama at Birmingham (UAB)-led study published in the April 2009 Journal of Prevention & Intervention in the Community.

In the study "Post-Hospital Medical Respite Care and Hospital Readmission of Homeless Persons", Stefan Kertesz, M.D., assistant professor in the UAB Division of Preventive Medicine, and colleagues looked at what happened to 743 homeless persons in Boston who had been hospitalized over a two-year period. They studied three groups: those who had been sent to Boston's homeless medical respite program, the Barbara McInnis House; those sent to other facilities not designed for the homeless; and those released into their own care.

Of the individuals studied, 136 (17 percent) were discharged to respite care, 174 (22 percent) to other planned care and 433 (55 percent) to their own care. Kertesz and his team found that the patients who were sent to respite care were somewhat older and sicker than the other two groups and, on initial analysis, did not find much difference in hospital readmission rates for the three groups.

However, once the team adjusted for the differences in patient characteristics, including severity of illness, those sent to respite care were about half as likely to be readmitted to the hospital as compared to patients who returned to the streets on discharge. Other planned care settings, such as nursing homes, did not achieve a similar reduction in the likelihood of readmission.

"Recovering at home is not an option for the person who doesn't have a home," Kertesz said. "Nursing homes and rehabilitation facilities have traditionally focused on the elderly. They are not always ready to receive patients who are young, potentially troubled by addiction or mental illness, and uninsured. And the streets are not a good place to recover for the homeless patient with an infected leg, a new cancer or a slow-improving pneumonia."

Kertesz said this study supports observational data from a 2006 study of 161 people from a Chicago respite program that showed discharge from a county hospital to a local respite program was associated with significantly fewer days of hospital care during the subsequent 12 months. That study also found that patients sent to respite care were half as likely to be readmitted as those released into their own care.

"Since 1985, 48 medical respite programs for the homeless have opened in cities from Boston to Savannah," Kertesz said. "Now, we have data from multiple studies that suggests a link between respite care and positive outcomes for homeless persons hospitalized with an acute illness.

"An early readmission to the hospital is typically a sign that the discharge plan has failed," he said. "This study shows that for persons who are homeless, it can be prevented. The findings should spur further research and lend impetus to recognition of this service."

Co-authors on the study were: Michael A. Posner, Ph.D., Villanova University; James J. O'Connell, M.D., Harvard Medical School and Boston University School of Medicine; Stacy Swain, M.P.H., Boston Health Care for the Homeless Program; Ashley N. Mullins, B.S., The Wright Institute, Oakland, Calif.; and Michael Shwartz, Ph.D., and Arlene S. Ash, Ph.D., Boston University.

The study was funded by the UAB Lister Hill Center on Health Policy, the National Institute on Drug Abuse and Boston Health Care for the Homeless Program.

About UAB

The UAB Division of Preventive Medicine is dedicated to medicine and the health of the public through research, teaching and dissemination and translation of knowledge for improved health outcomes. From its inception in 1967, the division has played a key role in the many groundbreaking trials contributing to the knowledge of medical and health systems, behavioral aspects of disease, epidemiology, prevention, control, and disease outcomes. Special concern for health disparities and a desire to promote women's health guide many division activities. A research-oriented division, it also has active programs for the training of post doctoral fellows and clinical scholars.