Development of a homelessness risk screening tool for emergency department patients

OBJECTIVE: To develop a screening tool to identify emergency department (ED) patients at risk of entering a homeless shelter, which could inform targeting of interventions to prevent future homelessness episodes.

DATA SOURCES: Linked data from (1) ED patient baseline questionnaires and (2) citywide administrative homeless shelter database.

STUDY DESIGN: Stakeholder-informed predictive modeling utilizing ED patient questionnaires linked with prospective shelter administrative data. The outcome was shelter entry documented in administrative data within 6 months following the baseline ED visit. Exposures were responses to questions on homelessness risk factors from baseline questionnaires.

DATA COLLECTION/EXTRACTION METHODS: Research assistants completed questionnaires with randomly sampled ED patients who were medically stable, not in police/prison custody, and spoke English or Spanish. Questionnaires were linked to administrative data using deterministic and probabilistic matching.

PRINCIPAL FINDINGS: Of 1993 ED patients who were not homeless at baseline, 5.6% entered a shelter in the next 6 months. A screening tool consisting of two measures of past shelter use and one of past criminal justice involvement had 83.0% sensitivity and 20.4% positive predictive value for future shelter entry.

CONCLUSIONS: Our study demonstrates the potential of using cross-sector data to improve hospital initiatives to address patients’ social needs.

Full citation:
Doran KM, Johns E, Zuiderveen S, Shinn M, Dinan K, Schretzman M, Gelberg L, Culhane D, Shelley D, Mijanovich T (2022).
Development of a homelessness risk screening tool for emergency department patients
Health Services Research, 57 (2), 285-293. doi: 10.1111/1475-6773.13886. PMCID: PMC8928028.