Coordinated transitions from hospital to shelter
for homeless patients may improve outcomes, yet patient-centered data
to guide interventions are lacking.
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 with a community-based participatory research approach, in
partnership with personnel and clients from a homeless shelter.
Ninety-eight homeless individuals at a shelter who reported at least one acute care visit to an area hospital in the last year.
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.
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.
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. (Authors)