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Predictors of Emergency Department Visits and Inpatient Admissions Among Homeless and Unstably Housed Adolescents and Young Adults

Mackelprang, Jessica L., PhD*,†; Qiu, Qian, MBA†,‡; Rivara, Frederick P., MD, MPH†,‡

doi: 10.1097/MLR.0000000000000436
Original Articles

Background: Individuals under age 25 years are estimated to comprise one third of the homeless population nationally. Understanding the reasons for utilization of hospitals by homeless youth is important for optimizing disposition planning.

Objectives: Objectives of the present study were to: (1) report prevalence of emergency department (ED) and inpatient admissions among homeless and unstably housed youth; (2) describe demographic characteristics of those youth who seek hospital care; (3) describe their patterns of injury, illness, psychiatric, and substance use conditions; and (4) identify demographic and diagnostic predictors of ED visit or hospital readmission.

Methods: Retrospective cohort study of 15–25-year-olds (N=402) who were admitted to the ED or inpatient floors of 2 urban teaching hospitals in King County, WA between July 1, 2009 and June 30, 2012 and whose address was “homeless” or “none” or a homeless shelter or service agency (ie, homeless or unstably housed), during any recorded encounter between July 1, 2009 and June 30, 2012.

Results: A total of 1151 ED visits and 227 inpatient admissions were documented. Fifty percent of patients had an ED visit or hospital readmission within 1 year, with 43.1% receiving care within 30 days of discharge. Cox regression showed that female individuals with an injury diagnosis (hazard ratio=1.74, 95% confidence interval=1.06, 2.85) and male individuals with an acute medical condition (hazard ratio=1.59, 95% confidence interval=1.09, 2.32) at index visit were more likely to have an ED visit or hospital readmission during the following year, as were patients who provided a private address at their index visit.

Conclusions: Homeless young people who seek hospital care demonstrate a high rate of ED visits and hospital readmissions, with unique predictors of utilization associated with sex and housing status. Additional research is necessary to determine how best to transition these young people from hospital-based to community-based care.

*Department of Psychology, Seattle University

Harborview Injury Prevention & Research Center

Department of Pediatrics, University of Washington School of Medicine, Seattle, WA

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J.L.M. received fellowship support from the National Institute of Child Health and Human Development (T32-HD057822) during the preparation of this paper. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

The authors declare no conflict of interest.

Reprints: Jessica L. Mackelprang, PhD, Department of Psychology, Seattle University, 901 12th Avenue, Seattle, WA 98122. E-mail:

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