Readmissions and disposition at discharge among persons experiencing homelessness with a dermatologic hospitalization

Summary: Abstract Body: Persons experiencing homelessness (PEH) face higher readmission rates, which may be influenced by patient-directed discharges that stem from competing life priorities or healthcare experiences of stigma and discrimination. We sought to examine if discharge patterns among PEH with dermatologic admissions are related to readmissions. This cross-sectional study used the Healthcare Cost and Utilization Project State Inpatient Databases for Florida, Massachusetts, and New York (2014–15) to identify PEH ≥ 18 years hospitalized with a primary dermatologic diagnosis. We developed multi-level mixed effect models where the binary outcome was 30-day all-cause readmission, primary exposure was discharge disposition, and confounders were age, sex, race-ethnicity, Elixhauser comorbidity index (includes mental illness and substance use disorders), insurance status; state as a random effect. Among 2,957 PEH hospitalized for a primary dermatologic diagnosis, the most common causes for admission were skin and soft tissue infection (77.5%), ulcers (8.2%), and venous stasis/lymphedema (4.7%). 20.0% (592) were readmitted within 30 days, with 30.2% (179) having a primary dermatologic diagnosis at readmission. Readmitted patients were older and a greater proportion were male, White, uninsured, and had mental illness (p<0.01). Patients with patient-directed discharges were more than twice as likely to be readmitted compared to routine discharges (aOR 2.4, 95% CI 1.8–3.2). Patient-directed discharges showed the highest readmission probability (31%, 95% CI 21.9–41.8), followed by discharge to home health care (24%, 95% CI 16.2–33.9), skilled nursing facility or intermediate care facility (18.7%, 95% CI 12.4–27.2), and routinely (15.7%, 95% CI 11.0–22.0). Addressing factors motivating patient-directed discharges, such as stigma, unmet medical needs, or competing priorities, may help reduce early discharges or convert a patient-directed discharge to routine discharge, enabling time for more robust discharge planning during dermatologic hospitalizations among PEH. Asmaa Mahoui¹, Laura M. Gottlieb¹, Katrina Abuabara¹, Jinoos Yazdany¹, Aileen Chang¹ 1. UCSF, School of Medicine, San Francisco, CA, United States. Minoritized Populations and Health Disparities Research