Continuity of Care among People Experiencing Homelessness and Mental Illness: Does Community Follow-up Reduce Rehospitalization?

The high prevalence of comorbid mental and physical illnesses among people experiencing homelessness results in high rates of hospitalization for this sub-population compared to the general public (Kushel, Vittinghoff, and [...]
Objective. To examine whether timely outpatient follow-up after hospital discharge reduces the risk of subsequent rehospitalization among people experiencing homelessness and mental illness. Data Sources. Comprehensive linked administrative data including hospital admissions, laboratory services, and community medical services. Study Design. Participants were recruited to the Vancouver At Home study based on a-priori criteria for homelessness and mental illness (n = 497). Logistic regression analysis was used to assess the relationship between outpatient care within 7 days postdis-charge and subsequent rehospitalization over a 1-year period. Data Extraction. Data were extracted for a consenting subsample of participants (n = 433) spanning 5 years prior to study enrollment. Principal Findings. More than half of the eligible sample (53 percent; n = 128) were rehospitalized within 1 year following an index hospital discharge. Neither outpatient medical services nor laboratory services within 7 days following discharge were associated with a significantly reduced likelihood of rehospitalization within 2 months (AOR = 1.17 [CI = 0.94, 1.46]), 6 months (AOR = 1.00 [CI = 0.82, 1.23]) or 12 months (AOR = 1.24 [CI = 1.02,1.52]). Conclusions. In contrast to evidence from nonhomeless samples, we found no association between timely outpatient follow-up and the likelihood of rehospitalization in our homeless, mentally ill cohort. Our findings indicate a need to address housing as an essential component of discharge planning alongside outpatient care. Key Words. Continuity of care, homelessness, health services, mental illness