title: Improving the quality of discharge care for the homeless: a patient-centered approach.
abstract: Homeless patients are at risk for low-quality discharge care, yet there are limited patient-centered data to guide improvement. We explored relationships between assessment of housing status by hospital staff and quality of discharge care using quantitative and qualitative data from interviews and chart reviews with 98 homeless patients: 80% male, mean homelessness 2.8 years, mean age 44. Patient-reported performance of discharge care varied substantially across seven domains from 16-75% and chart review documented lower performance than patient report. Over half (56%) were not asked about their housing status and multivariable logistic regression showed assessment of housing status was independently associated with higher performance in five domains: discussions about cost of medications, physical activity levels, diet, transportation, and mental health follow-up. Qualitative data revealed patient concerns about stigmatization from disclosure of housing status. Our findings suggest that addressing housing status in acute care settings while avoiding stigmatization may improve discharge care for homeless patients.
authors.affiliation: Division of Hospital Medicine, University of California, San Francisco, San Francisco, CA 94143-0131, USA. Ryan.Greysen@ucsf.edu
authors.forename: S Ryan
authors.initials: SR
authors.lastname: Greysen
authors.forename: Rebecca
authors.initials: R
authors.lastname: Allen
authors.forename: Marjorie S
authors.initials: MS
authors.lastname: Rosenthal
authors.forename: Georgina I
authors.initials: GI
authors.lastname: Lucas
authors.forename: Emily A
authors.initials: EA
authors.lastname: Wang
mesh_terms: D000328:Adult; D055812:Community-Based Participatory Research; D003237:Connecticut; D003266:Continuity of Patient Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D003430:Cross-Sectional Studies; D005260:Female; D006703:Ill-Housed Persons; D006798:Housing; D006801:Humans; D008297:Male; D008875:Middle Aged; D010351:Patient Discharge; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000706:statistics & numerical data; D044469:Racial Groups; D057545:Social Stigma