Development of a homelessness risk screening tool for emergency department patients

Kelly M Doran; Eileen Johns; Sara Zuiderveen; Marybeth Shinn; Kinsey Dinan; Maryanne Schretzman; Lillian Gelberg; Dennis Culhane; Donna Shelley; Tod Mijanovich

doi:10.1111/1475-6773.13886

Development of a homelessness risk screening tool for emergency department patients

Health Serv Res. 2022 Apr;57(2):285-293. doi: 10.1111/1475-6773.13886. Epub 2021 Oct 20.

Authors

Kelly M Doran^{1

2}, Eileen Johns³, Sara Zuiderveen⁴, Marybeth Shinn⁵, Kinsey Dinan⁶, Maryanne Schretzman³, Lillian Gelberg^{7

8

9}, Dennis Culhane¹⁰, Donna Shelley¹¹, Tod Mijanovich¹²

Affiliations

¹ Department of Emergency Medicine, NYU School of Medicine, New York, New York, USA.
² Department of Population Health, NYU School of Medicine, New York, New York, USA.
³ NYC Center for Innovation through Data Intelligence, New York, New York, USA.
⁴ Prevention and Housing Support, Homelessness Prevention Administration, NYC Human Resources Administration, New York, New York, USA.
⁵ Department of Human and Organizational Development, Vanderbilt University, Nashville, Tennessee, USA.
⁶ Office of Research and Policy Innovation, NYC Department of Social Services, New York, New York, USA.
⁷ Department of Family Medicine, David Geffen School of Medicine at UCLA, Los Angeles, California, USA.
⁸ Department of Health Policy and Management, UCLA Fielding School of Public Health, Los Angeles, California, USA.
⁹ Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, California, USA.
¹⁰ School of Social Policy and Practice, University of Pennsylvania, Philadelphia, Pennsylvania, USA.
¹¹ Public Health Policy and Management, NYU School of Global Public Health, New York, New York, USA.
¹² Applied Statistics and Health Policy, Department of Applied Statistics, Social Science, and Humanities, NYU Steinhardt School, New York, New York, USA.

Abstract

Objective: To develop a screening tool to identify emergency department (ED) patients at risk of entering a homeless shelter, which could inform targeting of interventions to prevent future homelessness episodes.

Data sources: Linked data from (1) ED patient baseline questionnaires and (2) citywide administrative homeless shelter database.

Study design: Stakeholder-informed predictive modeling utilizing ED patient questionnaires linked with prospective shelter administrative data. The outcome was shelter entry documented in administrative data within 6 months following the baseline ED visit. Exposures were responses to questions on homelessness risk factors from baseline questionnaires.

Data collection/extraction methods: Research assistants completed questionnaires with randomly sampled ED patients who were medically stable, not in police/prison custody, and spoke English or Spanish. Questionnaires were linked to administrative data using deterministic and probabilistic matching.

Principal findings: Of 1993 ED patients who were not homeless at baseline, 5.6% entered a shelter in the next 6 months. A screening tool consisting of two measures of past shelter use and one of past criminal justice involvement had 83.0% sensitivity and 20.4% positive predictive value for future shelter entry.

Conclusions: Our study demonstrates the potential of using cross-sector data to improve hospital initiatives to address patients' social needs.

Keywords: delivery of health care; emergency service; homeless persons; hospital; housing; social problems.

Publication types

Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't

MeSH terms

Emergency Service, Hospital
Housing
Humans
Ill-Housed Persons*
Prospective Studies
Surveys and Questionnaires

Grants and funding

K23 DA039179/DA/NIDA NIH HHS/United States