Preventable hospital admissions among the homeless in California: An analysis of patient characteristics and ambulatory care sensitive conditions

Background: Hospital admissions for ambulatory care sensitive conditions (ACSCs) can be used as an indicator of access to primary care services. In the general population, demographic characteristics such as gender and race have been identified as predictors for ACSC hospital admissions. To date there is limited research examining admissions for ACSC among one of the most underserved populations; the homeless. Methods: To identify characteristics among the homeless associated with ACSC admissions we conducted a retrospective analysis of the 2010 California State Inpatient Database. The primary outcome measure was admissions with an ACSC primary diagnosis. Descriptive statistics and multiple logistic regressions were performed to determine predictors of being admitted for an ACSC. Results: Of the 19,624 hospital admissions among the homeless, ACSCs were responsible for 8.98% admissions. Most admissions were among men (74.9%) and non-Hispanic whites (57.2%) (mean age = 44.3±12.8). Medicare and Medicaid were the primary expected payers (15.6% and 30.9%, respectively). Among women, 3.4% had a discharge with a neonatal and/or maternal diagnosis. Women were 11% less likely to have an ACSC as the reason for their hospital admission (p=0.0442). African Americans were 1.4 times more likely to be admitted for an ACSC (p<.0001). Conclusion: The findings from this study can be used to tailor public health interventions targeting the homeless. Future research identifying specific ACSCs can identify what preventive services are needed to assist with program planning and policy making. The findings reported here will help fill a gap in the literature related to ACSC hospital admissions among the homeless.