To compare the proportion of hospitalizations that result in an alternate level of care (ALC) designation among patients with a recent experience of homelessness versus matched patients from low-resource neighborhoods.
Approach:
Study Design: Matched cohort study using population-level linked administrative data in Ontario, Canada.
Data Sources: Utilized various administrative datasets including health care databases and the Ontario Marginalization Index.
Participant Selection: Included hospital discharges from April 1, 2022, to March 31, 2024, excluding certain patient groups and focusing on those with a recent experience of homelessness.
Key Findings:
Individuals experiencing homelessness face unique barriers leading to increased likelihood of ALC designation.
Absence of stable housing limits options for safe postdischarge care.
Patients experiencing homelessness are more likely to have complex medical, mental health, or substance use comorbidities.
Interpretation:
The study highlights the systemic challenges faced by unhoused individuals in transitioning from hospital to community care, contributing to longer ALC stays.
Limitations:
Limited empirical data on the prevalence and duration of ALC stays among hospitalized persons experiencing homelessness.
Potential confounding factors not fully addressed, such as age, sex, and level of morbidity.
Conclusion:
The findings indicate significant disparities in hospital discharge processes for individuals facing homelessness compared to those in low-resource neighborhoods.
In a planned BALANCE analysis, elevated day 7 procalcitonin was associated with higher mortality, but the small subgroup analysis found no evidence that extending antibiotics from 7 to 14 days improved outcomes.
