Risk for Acute Care Utilization in Housing-Insecure Adults

BACKGROUND: To identify patients at the highest risk for acute care utilization, health care systems have developed "hot spotter" programs. Homelessness is a robust social determinant of acute care utilization. OBJECTIVES: To describe the prevalence, patterns, and correlates of meeting criteria for a hot spotter program among housing-insecure adults in the US Veterans Health Administration (VHA). RESEARCH DESIGN: Among veterans on the VHA Homeless Registry in Fiscal Years 2018-2022 (N=1,469,893), we identified those who met criteria for a Hot Spotter Report [ie, ≥1 hospital admissions and/or ≥2 emergency department (ED) visits in at least one quarter], described their patterns of acute care use, and examined differences in patient characteristics and outpatient service use between those who met report criteria in multiple quarters (vs. one). RESULTS: Thirty percent (N=446,974) met report criteria in at least one quarter; most (56%) met report criteria in ≥2 quarters. Diagnoses of depression (58%) and/or a substance use disorder (51%) were common; however, the rate of hospitalization in an acute medical setting during the cohort period was twice that of being hospitalized in an acute mental health setting (50% vs. 25%). Being on the Hot Spotter Report in multiple quarters (vs. one) was associated with more chronic conditions (M=5.08 vs. 3.29), higher rates of suicidality (23.7% vs. 11.7%), and higher likelihood of all types of outpatient care ( P <0.0001). CONCLUSIONS: Given rates of chronic medical conditions and medical hospitalizations, it may behoove hot spotter programs to increase care coordination with medical respite programs to support patients in the postacute phase.