HIE Data Used To Study Healthcare Of Homeless
By Christine Kern, contributing writer
Researchers hope to leverage the study’s results to improve healthcare for the homeless.
Researchers from the Icahn School of Medicine at Mount Sinai Hospital in New York City leveraged data from a health information exchange (HIE) to identify patterns of homeless patients. It is hoped that this effort could lead to improved care for this population, Healthcare Dive reports.
For the study, researchers examined Healthix, a New York-based HIE, and found homeless patients experience worse outcomes (a three to four fold increase in mortality rate) and consume a disproportionate amount of healthcare resources (four times more than the average Medicaid patient) compared to the rest of the population.
The study, Identifying Homelessness Using Health Information Exchange Data, was published in a recent issue of the Journal of the American Medical Informatics Association (JAMIA).
According to the study abstract, there is great interest on the part of the federal government to coordinate care for homeless patients, but this will require systematic identification of these individuals, a task that presents a herculean challenge for many healthcare providers. The study authors hope to provide a tool to help reduce extraneous utilization of services by the homeless by using the HIE records to identify patients who may be homeless.
The Mount Sinai researchers used the data to match the patients' record with their names and date of birth, and then subsequently assigned the patients to appropriate address categories based on their registration forms. Homeless categories were applied when patients registered with the address of a hospital, homeless shelter, place of worship, or an address containing a keyword synonymous with “homelessness,” according to the researchers’ report.
The study found that homeless patients visited, on average, 2.02 healthcare facilities compared to 1.59 from domiciled patients. A majority of homeless patients made a transition between a proxy and non-proxy address, some even making four transitions.
The researchers believe similar investigations could be carried out using other HIEs. “Hospitals and HIEs use algorithms that rely on patient demographic data, including address data, to match patient records. We believe that better HIE record matching for homeless patients could improve HIE usefulness and HIE-enabled care coordination efforts aimed at helping this population.
“These findings demonstrate the difficulty of identifying homeless patients after they have accessed healthcare services. A patient’s housing status is frequently known to registration staff at the time a patient is registered, and we believe it may be beneficial to adopt a new policy that requires structured, standardized data on housing status to be collected whenever a patient registers for a healthcare encounter.”
The study concludes, “The use of health information exchange data enabled us to identify a large number of patients likely to be homeless and to observe the wide variation in registration practices for homeless patients within and across sites. Consideration of these results may suggest a way to improve the quality of record matching for homeless patients. Validation of these results is necessary to confirm the homeless status of identified individuals. Ultimately, creating a standardized and structured field to record a patient’s housing status may be a preferable approach.”