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June 11, 2019; 92 (24) Article

Hospital admission and readmission among homeless patients with neurologic disease: Retraction and replacement

Nicole Rosendale, Elan L. Guterman, John P. Betjemann, S. Andrew Josephson, Vanja C. Douglas
First published May 24, 2019, DOI: https://doi.org/10.1212/WNL.0000000000007645
Nicole Rosendale
From the Department of Neurology, University of California San Francisco Medical Center; and Weill Institute for Neurosciences, University of California San Francisco.
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Elan L. Guterman
From the Department of Neurology, University of California San Francisco Medical Center; and Weill Institute for Neurosciences, University of California San Francisco.
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John P. Betjemann
From the Department of Neurology, University of California San Francisco Medical Center; and Weill Institute for Neurosciences, University of California San Francisco.
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S. Andrew Josephson
From the Department of Neurology, University of California San Francisco Medical Center; and Weill Institute for Neurosciences, University of California San Francisco.
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Vanja C. Douglas
From the Department of Neurology, University of California San Francisco Medical Center; and Weill Institute for Neurosciences, University of California San Francisco.
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Hospital admission and readmission among homeless patients with neurologic disease: Retraction and replacement
Nicole Rosendale, Elan L. Guterman, John P. Betjemann, S. Andrew Josephson, Vanja C. Douglas
Neurology Jun 2019, 92 (24) e2822-e2831; DOI: 10.1212/WNL.0000000000007645

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This article has a correction. Please see:

  • Hospital Admission and Readmission Among Homeless Patients With Neurologic Disease - July 27, 2021
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Abstract

Objective To characterize the most common neurologic diagnoses leading to hospitalization for homeless compared to housed individuals and to assess whether homelessness is an independent risk factor for 30-day readmission after an admission for a neurologic illness.

Methods We performed a retrospective serial cross-sectional study using data from the Healthcare Cost and Utilization Project California State Inpatient Database from 2006 to 2011. Adult patients with a primary neurologic discharge diagnosis were included. The primary outcome was 30-day readmission. We used multilevel logistic regression to examine the association between homelessness and readmission after adjustment for patient factors.

Results We identified 1,082,347 patients with a neurologic primary diagnosis. The rate of homelessness was 0.37%. The most common indications for hospitalization among homeless patients were seizure and traumatic brain injury, both of which were more common in the homeless compared to housed population (19.3% vs 8.1% and 31.9% vs 9.2%, respectively, p < 0.001). A multilevel mixed-effects model controlling for patient age, sex, race, insurance type, comorbid conditions, and clustering on the hospital level found that homelessness was associated with increased 30-day readmission (odds ratio 1.5, 95% confidence interval 1.4–1.6, p < 0.001). This association persisted after this analysis was repeated within specific diagnoses (patients with epilepsy, trauma, encephalopathy, and neuromuscular disease).

Conclusion The most common neurologic reasons for admission among homeless patients are seizure and traumatic brain injury; these patients are at high risk for readmission. Future interventions should target the drivers of readmissions in this vulnerable population.

Glossary

CCS=
Clinical Classification Software;
CI=
confidence interval;
HCUP=
Healthcare Cost and Utilization Project;
ICD-9=
International Classification of Diseases, 9th revision;
ICD-9-CM=
International Classification of Diseases, 9th revision, clinical; modification;
OR=
odds ratio;
SID=
State Inpatient Database;
TBI=
traumatic brain injury

Footnotes

  • The original article has been retracted and replaced. The original article may be found here: http://links.lww.com/WNL/B99.

  • Go to Neurology.org/N for full disclosures. Funding information and disclosures deemed relevant by the authors, if any, are provided at the end of the article.

  • Editorial, page 1131

  • CME Course: NPub.org/cmelist

  • Received April 13, 2020.
  • Accepted in final form April 13, 2020.
  • © 2019 American Academy of Neurology
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