Assessing the Utility of a Population Segmentation Tool to Determine Medical Vulnerability Among Adults Experiencing Homelessness

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BACKGROUND: Patients experiencing homelessness (PEH) have intersecting medical, social, and behavioral needs. To meet their needs, promising medical respite and integrated care models have been developed. The use of validated population segmentation screening tools is paramount for equitable triage and tailored service delivery. The Simple Segmentation Tool (SST), consisting of global impression categories (GI) and complicating factors (CFs), was developed to identify health and social service needs for whole-person care planning but has not been used to assess medical vulnerability among PEH. OBJECTIVE: Evaluate the association between SST scores and medical vulnerability among PEH. DESIGN: Retrospective cohort study conducted between November 2018 and November 2020 of a medical respite program using electronic health record (EHR) data. PARTICIPANTS: PEH referred to a transitional care program in the southeastern United States. MAIN MEASURES: We describe GI categories and CFs as the independent variables of interest and report their unadjusted and adjusted relationship using a Poisson regression modeling approach with outcomes of interest including bed days, emergency department (ED) visits, inpatient and observation admissions, and Elixhauser comorbidity index score after adjusting for demographic characteristics. RESULTS: Among 267 adults (mean age 51.2, 72% African American, 70.8% male), in an adjusted model, the presence of CFs was associated with a higher number of hospital stays, ED visits, and inpatient admissions. GI scores were associated with higher rates of bed days, ED visits, and Elixhauser conditions but lower observation admissions. CONCLUSION: SST scores were associated with utilization patterns and comorbidity burden after adjusting for age, gender, and race among an adult population experiencing homelessness. These findings suggest that the SST may be a preferable assessment than existing triage tools to objectively capture medical vulnerability and support care planning.

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