Hospital utilization by people experiencing homelessness in Massachusetts: A preview of what is to come?

Access to health care for persons experiencing homelessness will increase through the Affordable Care Act, but it is not known how this will impact health care reform for this and other vulnerable populations. This presentation will describe two years of hospital utilization by people without homes in Boston, a city with a rich network of homeless services and where most individuals experiencing homelessness have access to health insurance. All admissions to Massachusetts General Hospital (MGH) between 1/1/2011 and 12/31/2012 were reviewed, and subjects were included if they had ever seen any provider at MGH. Demographic variables were extracted from the Boston Health Care for the Homeless Program electronic record and clinical variables from the Massachusetts General Hospital electronic record. 876 subjects accounted for 1703 unique admissions during the study period. 95 percent had government-sponsored health insurance and 110 subjects had more than 4 admissions. Admissions related to substance use disorders were the most common. At least 11 percent of subjects were discharged against medical advice and 19.1 percent of patients were readmitted to the MGH within 30 days. The presentation will explain that, in this cohort, persons experiencing homelessness were admitted to the hospital for addiction-related concerns and had high rates of AMA discharge and readmission. We will conclude by drawing lessons from the data—primarily that integration of primary care and behavioral health, collaboration between inpatient and outpatient providers, and homelessness-specific transitional care programs are necessary to provide high value care to a vulnerable population as access expands.