Understanding transitions in care from hospital to homeless shelter: a mixed-methods, community-based participatory approach.
BACKGROUND
Coordinated transitions from hospital to shelter for homeless patients may improve outcomes, yet patient-centered data to guide interventions are lacking.


OBJECTIVE
To understand patients' experiences of transitions from hospital to a homeless shelter, and determine aspects of these experiences associated with perceived quality of these transitions.


METHODS
Mixed methods with a community-based participatory research approach, in partnership with personnel and clients from a homeless shelter.


METHODS
Ninety-eight homeless individuals at a shelter who reported at least one acute care visit to an area hospital in the last year.


METHODS
Using semi-structured interviews, we collected quantitative and qualitative data about transitions in care from the hospital to the shelter. We analyzed qualitative data using the constant comparative method to determine patients' perspectives on the discharge experience, and we analyzed quantitative data using frequency analysis to determine factors associated with poor outcomes from patients' perspective.


RESULTS
Using qualitative analysis, we found homeless participants with a recent acute care visit perceived an overall lack of coordination between the hospital and shelter at the time of discharge. They also described how expectations of suboptimal coordination exacerbate delays in seeking care, and made three recommendations for improvement: 1) Hospital providers should consider housing a health concern; 2) Hospital and shelter providers should communicate during discharge planning; 3) Discharge planning should include safe transportation. In quantitative analysis of recent hospital experiences, 44 % of participants reported that housing status was assessed and 42 % reported that transportation was discussed. Twenty-seven percent reported discharge occurred after dark; 11 % reported staying on the streets with no shelter on the first night after discharge.


CONCLUSIONS
Homeless patients in our community perceived suboptimal coordination in transitions of care from the hospital to the shelter. These patients recommended improved assessment of housing status, communication between hospital and shelter providers, and arrangement of safe transportation to improve discharge safety and avoid discharge to the streets without shelter.
Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Avenue, Room U127A, Box 131, San Francisco, CA, 94143-0131, USA. Ryan.Greysen@ucsf.edu
S Ryan
SR
Greysen
Rebecca
R
Allen
Georgina I
GI
Lucas
Emily A
EA
Wang
Marjorie S
MS
Rosenthal
D000293:Adolescent; D000328:Adult; D000368:Aged; D003142:Communication; D055812:Community-Based Participatory Research; D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000523:psychology*; D006761:Hospitals; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge / Q000592:standards*; D017060:Patient Satisfaction; D010360:Patient Transfer / Q000706:statistics & numerical data*; D011787:Quality of Health Care / Q000592:standards*; D055815:Young Adult