title: Hospital Readmissions in a Community-based Sample of Homeless Adults: a Matched-cohort Study.
abstract: Hospital readmission rates are a widely used quality indicator that may be elevated in disadvantaged populations.
  
  
  
  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.
  
  
  
  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.
  
  
  
  This study examined a cohort of 1,165 homeless adults recruited at homeless shelters and meal programs in Toronto, Ontario, between 6 December 2004 and 20 December 2005.
  
  
  
  The primary outcome was the occurrence of an unplanned medical or surgical readmission within 30 days of discharge from hospital.
  
  
  
  Between 6 December 2004 and 31 March 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.
  
  
  
  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.
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute at St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8. dima.saab@mail.utoronto.ca.
authors.forename: Dima
authors.initials: D
authors.lastname: Saab
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute at St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.
authors.forename: Rosane
authors.initials: R
authors.lastname: Nisenbaum
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute at St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.|Division of General Internal Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.
authors.forename: Irfan
authors.initials: I
authors.lastname: Dhalla
authors.affiliation: Centre for Research on Inner City Health, Li Ka Shing Knowledge Institute at St. Michael's Hospital, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.|Division of General Internal Medicine, Department of Medicine, University of Toronto, 30 Bond Street, Toronto, Ontario, Canada, M5B 1W8.
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Hwang
mesh_terms: D000328:Adult; D015331:Cohort Studies; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D008297:Male; D008875:Middle Aged; D009864:Ontario / Q000453:epidemiology; D010359:Patient Readmission / Q000639:trends*; D011203:Poverty / Q000639:trends*; D012111:Residence Characteristics
keywords: administrative health data; homeless persons; hospital readmissions; matched-cohort