Six years ago, US hospitals officially gained the ability to document patients’ housing status, including housing instability and homelessness. The new “Z-codes” reflect a growing recognition of housing’s role as a major social determinant of health.
The study harnessing this data reveals significant differences in prognosis between patients with housing problems and those who are not admitted to hospitals. This includes a A sharp division in the care of mental, behavioral and neurodevelopmental conditions.
Researchers from the University of Michigan Institute for Health Care Policy and InnovationHe says their findings show the importance of improving housing state tracking in health care, and working to address housing as a social driver of health.
Only hospital staff reported any type of housing instability for 1% of hospital admissions in the national sample studied, according to the new study published in JAMA Network is open By a team led by an IHPI scientist Kimberly Rawlings, Ph.D. Almost all of these patients were recorded as having homelessness, although Z-codes present 5 different categories of housing instability.
In all, 50% of hospital stays for people with documented housing problems were for mental, behavioral and neurodevelopmental care. This is ten times higher than the percentage of hospital stays for these conditions by people who did not record housing instability in their scheme.
Patients with documented housing instability also had longer hospital stays. On average, they stayed two more days.
Patients with documented housing instability also accounted for 10% of inpatient days for mental, behavioral and neurodevelopmental care. These conditions often require long waiting times for beds, so any reduction in length of stay could improve access for all.
The study uses data from the national inpatient sample, which captures 20% of all hospital general care services to provide nationally representative estimates of hospital care across types of insurance. The authors used data from 2017 to 2019, when coding for social determinants of health became more common.
The cost of hospital care for people with documented housing instability in this sample was $9.5 billion, with $3.5 billion of that cost attributable to care for mental, behavioral, and neurodevelopmental conditions.
Since people with housing problems were more likely than others to have Medicaid coverage (55%) or no insurance (12%), it is likely that the brunt of these costs will fall on state programs and hospitals.
Putting it all together, the authors explain, “our findings establish the working case for synergistic collaboration between housing, hospital, and mental health experts.”
“Because Z-codes were not used, our findings are likely the tip of the iceberg,” Rawlings said. “If we are to improve care for these individuals, and make best use of hospital beds, healthcare professionals and their institutions need to do more to improve screening for this important social driver.”
used in Fellowship Program in Health Research and Design Led by Andrew M. Abraham, MD, MA, lead author of the study. Ibrahim is a surgeon, clinical scientist, and researcher in healthcare design in the Michigan Department of Surgery.
“This important work led by a housing expert using health care data is exactly why we started this fellowship. We need more multidisciplinary work like that led by Dr. Rawlings,” Ibrahim said.
In addition to Rawlings and Abraham, the new study’s authors are Nicholas Kunath, MD, of the Department of Surgery. Caitlin R. Rios, MD, MPH from Yale University; and IHPI National Clinical Scholar Alexander T. Janke, MD, MHS
Paper cited: “Association of Coded Housing Instability and Hospitalization in the United States,” GammaNet is open. DOI: 10.1001/jamanetworkopen.2022.41951