Use of health care utilization as a metric of intervention success may perpetuate racial disparities: An outcome evaluation of a homeless transitional care program.
Raman Nohria, Donna J Biederman, Richard Sloane and 1 others
PMID 35899908WHAT IT FOUND
Black and White people experiencing homelessness referred to a transitional care program showed no difference in health care use or mortality, but Black participants who completed the program had fewer 30 and 90 day emergency department revisits than White participants.
Key findings
01Among people referred to the program, Black and White patients showed no statistically significant race differences in hospital admissions, bed days, emergency visits, observation encounters, outpatient visits, or 6 month mortality.
02Both Black and White participants had lower mean hospital admissions, bed days, and emergency visits after program exit than before enrollment.
03After program completion, Black participants revisited the emergency department less often than White participants at 30 days (10.6% vs 24.3%) and 90 days (24.7% vs 43.2%).
STILL TO COME
How it was doneWhat they foundWhat it means for RNs
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What it does not show
The study did not talk with participants, so it cannot say which part of the program mattered or why emergency visits were lower. It counted only care inside Duke University Health System and the local federally qualified health center, so care elsewhere was missed. Only adults were studied, so it may not apply to younger homeless people. It only compared Black and White people, so other racial and ethnic groups were not examined. The participant subgroup was small, and comorbid conditions were not assessed in participants because of sample size. The data did not separate planned from avoidable emergency visits or admissions. Seven of 122 participants had missing post program data.
Declared interests
No author conflict of interest or funding declaration appears in the supplied article text. The supplied publication types list non-U.S. government research support.
The easy way to misread this
Do not read lower emergency department revisits among Black participants as evidence that they are healthier or need less care. Black people in the study had higher diabetes, kidney failure, and HIV prevalence, and the study did not explain the lower return rate.