scholarly journals Differences in Clinical Outcomes of Adults Referred to a Homeless Transitional Care Program Based on Multimorbid Health Profiles: A Latent Class Analysis

2021 ◽  
Vol 12 ◽  
Author(s):  
Colin M. Smith ◽  
Jacob Feigal ◽  
Richard Sloane ◽  
Donna J. Biederman

Background: People experiencing homelessness face significant medical and psychiatric illness, yet few studies have characterized the effects of multimorbidity within this population. This study aimed to (a) delineate unique groups of individuals based on medical, psychiatric, and substance use disorder profiles, and (b) compare clinical outcomes across groups.Methods: We extracted administrative data from a health system electronic health record for adults referred to the Durham Homeless Care Transitions program from July 2016 to June 2020. We used latent class analysis to estimate classes in this cohort based on clinically important medical, psychiatric and substance use disorder diagnoses and compared health care utilization, overdose, and mortality at 12 months after referral.Results: We included 497 patients in the study and found 5 distinct groups: “low morbidity” (referent), “high comorbidity,” “high tri-morbidity,” “high alcohol use,” and “high medical illness.” All groups had greater number of admissions, longer mean duration of admissions, and more ED visits in the 12 months after referral compared to the “low morbidity” group. The “high medical illness” group had greater mortality 12 months after referral compared to the “low morbidity” group (OR, 2.53, 1.03–6.16; 95% CI, 1.03–6.16; p = 0.04). The “high comorbidity” group (OR, 5.23; 95% CI, 1.57–17.39; p < 0.007) and “high tri-morbidity” group (OR, 4.20; 95% CI, 1.26–14.01; p < 0.02) had greater 12-month drug overdose risk after referral compared to the referent group.Conclusions: These data suggest that distinct groups of people experiencing homelessness are affected differently by comorbidities, thus health care programs for this population should address their risk factors accordingly.

Author(s):  
Bruce G Taylor ◽  
Weiwei Liu ◽  
Elizabeth A. Mumford

The purpose of this study is to understand the availability of employee wellness programs within law enforcement agencies (LEAs) across the United States, including physical fitness, resilience/wellness, coping skills, nutrition, mental health treatment, and substance use treatment. The research team investigated whether patterns of LEA wellness programming are identifiable and, if so, what characteristics describe these patterns. We assess using latent class analysis whether there are distinct profiles of agencies with similar patterns offering different types of wellness programs and explore what characteristics distinguish agencies with certain profiles of wellness programming. Data were from a nationally representative sample of 1135 LEAs: 80.1% municipal, 18.6% county and 1.3% other agencies (state-level and Bureau of Indian Affairs LEAs). We found that many agencies (62%) offer no wellness programming. We also found that 23% have comprehensive wellness programming, and that another group of agencies specialize in specific wellness programming. About 14% of the agencies have a high probability of providing resilience coping skill education, mental health and/or substance use treatment services programming. About 1% of the agencies in the United States limit their programming to fitness and nutrition, indicating that fitness and nutrition programs are more likely to be offered in concert with other types of wellness programs. The analyses revealed that agencies offering broad program support are more likely to be large, municipal LEAs located in either the West, Midwest or Northeast (compared with the southern United States), and not experiencing a recent budget cut that impacted wellness programming.


2015 ◽  
Vol 151 ◽  
pp. 31-37 ◽  
Author(s):  
Sin How Lim ◽  
Doug H. Cheung ◽  
Thomas E. Guadamuz ◽  
Chongyi Wei ◽  
Stuart Koe ◽  
...  

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