The revolving hospital door: Hospital readmissions among patients who are homeless

Kelly M. Doran, Kyle T. Ragins, Andrea L. Iacomacci, Alison Cunningham, Karen J. Jubanyik, Grace Y. Jenq

Research output: Contribution to journalArticlepeer-review


BACKGROUND: National attention is increasingly focused on hospital readmissions. Little prior research has examined readmissions among patients who are homeless. OBJECTIVE: The aim of the study was to determine 30-day hospital readmission rates among patients who are homeless and examine factors associated with hospital readmissions in this population. METHODS: We conducted a retrospective chart review of patients who were homeless and hospitalized at a single urban hospital from May-August 2012. Homelessness was identified by an electronic medical record flag and confirmed by manual chart review. The primary outcome was all-cause hospital readmission to the study hospital within 30 days of hospital discharge. Patient-level and hospitalization-level factors associated with risk for readmission were examined using generalized estimating equations. RESULTS: There were 113 unique patients who were homeless and admitted to the hospital a total of 266 times during the study period. The mean age was 49 years, 27.4% of patients were women, and 75.2% had Medicaid. Half (50.8%) of all hospitalizations resulted in a 30-day hospital inpatient readmission and 70.3% resulted in either an inpatient readmission, observation status stay, or emergency department visit within 30 days of hospital discharge. Most readmissions occurred early after hospital discharge (53.9% within 1 week, 74.8% within 2 weeks). Discharge to the streets or shelter versus other living situations was associated with increased risk for readmission in multivariable analyses. CONCLUSIONS: Patients who were homeless had strikingly high 30-day hospital readmission rates. These findings suggest the urgent need for further research and interventions to improve postdischarge care for patients who are homeless.

Original languageEnglish (US)
Pages (from-to)767-773
Number of pages7
JournalMedical care
Issue number9
StatePublished - Sep 2013


  • Homelessness
  • Hospital quality
  • Readmissions

ASJC Scopus subject areas

  • Public Health, Environmental and Occupational Health


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