Homeless services data vs health records to recognize homelessness

This cross-sectional study compared data from the Homeless Management Information System with electronic health records to quantify how often homelessness was potentially missed during emergency department visits without admission and inpatient admissions; and identify factors associated with misses. 

Identifying patients as people experiencing homelessness allows clinicians to create patient-centered plans and refer to services at discharge. Since 2022, the Centers for Medicare & Medicaid Services requires screening for housing instability during admissions. We found homelessness was potentially missed in 39.2% of admissions, supporting universal screening using validated tools, like Veterans Affairs Homelessness Screening Clinical Reminder. Because ED visits were more frequent than admissions in our sample, screening and service linkage may have a greater impact if performed in EDs. 

The odds of potentially missed homelessness were almost 3-fold higher for ED visits. Rapid, problem-focused ED care may limit comprehensive history-taking or documentation. Psychiatric diagnosis was associated with identifying homelessness. Explanations include exhibiting behaviors cueing screening for homelessness or extensive psychiatric history-taking.