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Understanding Transitions in Care from Hospital to Homeless Shelter: a Mixed-Methods, Community-Based Participatory Approach

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ABSTRACT

BACKGROUND

Coordinated transitions from hospital to shelter for homeless patients may improve outcomes, yet patient-centered data to guide interventions are lacking.

OBJECTIVES

To understand patients’ experiences of transitions from hospital to a homeless shelter, and determine aspects of these experiences associated with perceived quality of these transitions.

DESIGNS

Mixed methods with a community-based participatory research approach, in partnership with personnel and clients from a homeless shelter.

PARTICIPANTS

Ninety-eight homeless individuals at a shelter who reported at least one acute care visit to an area hospital in the last year.

APPROACH

Using semi-structured interviews, we collected quantitative and qualitative data about transitions in care from the hospital to the shelter. We analyzed qualitative data using the constant comparative method to determine patients’ perspectives on the discharge experience, and we analyzed quantitative data using frequency analysis to determine factors associated with poor outcomes from patients’ perspective.

KEY RESULTS

Using qualitative analysis, we found homeless participants with a recent acute care visit perceived an overall lack of coordination between the hospital and shelter at the time of discharge. They also described how expectations of suboptimal coordination exacerbate delays in seeking care, and made three recommendations for improvement: 1) Hospital providers should consider housing a health concern; 2) Hospital and shelter providers should communicate during discharge planning; 3) Discharge planning should include safe transportation. In quantitative analysis of recent hospital experiences, 44 % of participants reported that housing status was assessed and 42 % reported that transportation was discussed. Twenty-seven percent reported discharge occurred after dark; 11 % reported staying on the streets with no shelter on the first night after discharge.

CONCLUSIONS

Homeless patients in our community perceived suboptimal coordination in transitions of care from the hospital to the shelter. These patients recommended improved assessment of housing status, communication between hospital and shelter providers, and arrangement of safe transportation to improve discharge safety and avoid discharge to the streets without shelter.

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Acknowledgements

The authors gratefully recognize the contributions of the members of our community who made this project possible. First, we thank the individuals experiencing homelessness who participated in pre-study and post-study focus groups, in addition to those who directly contributed to data collection by enrollment in the study. Similarly, our study would not be possible without the specific contributions of the staff at Columbus House including: Alison Cunningham, Malynda Mallory, Preston Fox, Kevin Guess and Ron Dunhill. We would also like to thank members of the Yale Robert Wood Johnson Foundation (RWJF) Steering Committee on Community Projects, the Yale New Haven Hospital Department of Social Work (Paula Crombie and Kathleen Tynan-McKiernan), the Cornell-Scott Hill Health Center Homeless Healthcare program and the Yale Homelessness and Hunger Action Panel.

We would also like to thank RWJF and the US Department of Veterans Affairs for funding through the Clinical Scholars program. The Yale Clinical Center for Investigation also supported the specific efforts of this program to develop community-based participatory research projects. Additionally, Dr. Wang is supported by the National Heart, Lung, and Blood Institute (NHLBI, K23 HL103720).

Data from this paper were presented at the 2011 Annual Meeting of the Society of General Internal Medicine and recognized with the Mack Lipkin Sr. Award for best presentation by an Associate Member.

Conflict of Interest

The authors declare that they do not have a conflict of interest. The contents of this article are solely the responsibility of the authors and do not necessarily represent the official views of the RWJF, the VA, or the NIH.

Author information

Author notes

  1. S. Ryan Greysen MD, MHS, MA

    Present address: Division of Hospital Medicine, University of California, San Francisco, 533 Parnassus Avenue, Room U127A, Box 131, San Francisco, CA, 94143-0131, USA

  2. Rebecca Allen LCSW

    Present address: The Whole in the Wall Gang Camp, New Haven, CT, USA

Authors and Affiliations

  1. Robert Wood Johnson Foundation Clinical Scholars Program, Yale University School of Medicine, New Haven, USA

    S. Ryan Greysen MD, MHS, MA

  2. Columbus House Inc., New Haven, CT, USA

    Rebecca Allen LCSW

  3. Robert Wood Johnson Clinical Scholars Program, Yale University School of Medicine, New Haven, USA

    Georgina I. Lucas MSW & Marjorie S. Rosenthal MD, MPH

  4. Department of Medicine, Yale University School of Medicine, New Haven, USA

    Emily A. Wang MD, MAS

  5. Department of Pediatrics, Yale University School of Medicine, New Haven, USA

    Marjorie S. Rosenthal MD, MPH

Authors
  1. S. Ryan Greysen MD, MHS, MA
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  4. Emily A. Wang MD, MAS
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  5. Marjorie S. Rosenthal MD, MPH
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Corresponding author

Correspondence to S. Ryan Greysen MD, MHS, MA.

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Greysen, S.R., Allen, R., Lucas, G.I. et al. Understanding Transitions in Care from Hospital to Homeless Shelter: a Mixed-Methods, Community-Based Participatory Approach. J GEN INTERN MED 27, 1484–1491 (2012). https://doi.org/10.1007/s11606-012-2117-2

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