Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013-2018.
Comparative 4-year risk and type of hospital admission among homeless and housed emergency department attendees: longitudinal study of hospital records in England 2013-2018.
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DOI：
10.1136/bmjopen-2021-049811
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发表时间：
2021-07-26
期刊：
影响因子：
2.9
通讯作者：
Allen T
中科院分区：
文献类型：
--
作者：
Moss C;Sutton M;Cheraghi-Sohi S;Sanders C;Allen T
无家可归的人经常使用二级保健。目前，在英格兰还没有对无家可归的病人进行潜在的可预防的入院研究。我们的目标是估计无家可归的患者可能预防的住院人数，并与具有相似特征的住院患者进行比较。回顾性匹配队列研究。英国的医院2013/2014年，在英格兰急诊科（艾德）就诊的16 161名无家可归患者和74 780名住院患者，根据年龄、性别、艾德就诊和初步诊断进行匹配。接下来4年（2014/2015-2017/2018）的入院、急诊入院、门诊护理敏感（ACS）急诊入院、急性ACS急诊入院和慢性ACS急诊入院的年度计数。此外，我们还比较了无家可归和居住患者的特定ACS疾病的患病率。每年每1000名患者的平均入院率为470名无家可归的患者和230名住院患者。调整混杂因素后，每年的入院率高出1.79倍。（发病率比（IRR）=1.79; 95% CI 1.69 - 1.90），急诊入院率高2.08倍（IRR=2.08; 95% CI 1.95 - 2.21），ACS入院率是住院患者的1.65倍（IRR=1.65; 95% CI 1.51 - 1.80）。急性ACS（IRR=1.78; 95% CI 1.64 - 1.93）的影响大于慢性ACS（IRR=1.45; 95% CI 1.27 - 1.66）。无家可归患者中相对更常见的ACS疾病是蜂窝织炎、抽搐/癫痫和慢性心绞痛。无家可归的病人使用医院服务的比率高于有住房的病人，特别是急诊病人。无家可归患者的ACS入院率较高，这表明通过改善初级保健，一些入院可能是可以预防的。然而，这些入院人数只占总入院人数的一小部分。
People experiencing homelessness are frequent users of secondary care. Currently, there is no study of potentially preventable admissions for homeless patients in England. We aim to estimate the number of potentially preventable hospital admissions for homeless patients and compare to housed patients with similar characteristics. Retrospective matched cohort study. Hospitals in England. 16 161 homeless patients and 74 780 housed patients aged 16–75 years who attended an emergency department (ED) in England in 2013/2014, matched on the basis of age, sex, ED attended and primary diagnosis. Annual counts of admissions, emergency admissions, ambulatory care-sensitive (ACS) emergency admissions, acute ACS emergency admissions and chronic ACS emergency admissions over the following 4 years (2014/2015–2017/2018). We additionally compare the prevalence of specific ACS conditions for homeless and housed patients. Mean admissions per 1000 patients per year were 470 for homeless patients and 230 for housed patients. Adjusted for confounders, annual admissions were 1.79 times higher (incident rate ratio (IRR)=1.79; 95% CI 1.69 to 1.90), emergency admissions 2.08 times higher (IRR=2.08; 95% CI 1.95 to 2.21) and ACS admissions 1.65 times higher (IRR=1.65; 95% CI 1.51 to 1.80), compared with housed patients. The effect was greater for acute (IRR=1.78; 95% CI 1.64 to 1.93) than chronic (IRR=1.45; 95% CI 1.27 to 1.66) ACS conditions. ACS conditions that were relatively more common for homeless patients were cellulitis, convulsions/epilepsy and chronic angina. Homeless patients use hospital services at higher rates than housed patients, particularly emergency admissions. ACS admissions of homeless patients are higher which suggests some admissions may be potentially preventable with improved access to primary care. However, these admissions comprise a small share of total admissions.
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影响因子：
2.9
作者：
Patel M;Lee SI;Levell NJ;Smart P;Kai J;Thomas KS;Leighton P
通讯作者：
Leighton P
影响因子：
28.2
作者：
Marks, Michael;Pollock, Emily;Doherty, Justin F.
通讯作者：
Doherty, Justin F.
影响因子：
4.4
作者：
Elwell-Sutton, Tim;Fok, Jonathan;Holland, Richard
通讯作者：
Holland, Richard
DOI：
10.1016/s0140-6736(14)61132-6
发表时间：
2014-10-25
期刊：
Lancet (London, England)
影响因子：
--
作者：
Fazel S;Geddes JR;Kushel M
通讯作者：
Kushel M
影响因子：
9.7
作者：
BILLINGS, J;ZEITEL, L;NEWMAN, L
通讯作者：
NEWMAN, L