The following syndrome was developed to explore emergency department visit records involving people experiencing homelessness. Trends over time, patient demographics, geographic distribution, and primary reasons for seeking care were explored. Additionally, we have been using this definition, in combination with other illness/injury specific definitions to assess the trends in among people experiencing homelessness (e.g., cold-related illness among people experiencing homelessness during record low temperatures).
The syndrome was developed in NSSP ESSENCE and is based on syndrome definitions provided by Maricopa County and Idaho.
The fields queried included: Chief Complaint History, Discharge Diagnosis, and Triage Note.
ICD coding appears to be relatively consistent. Triage notes are useful for context and adding information regarding housing status (i.e. staying at a shelter, recently lost housing, chronic homelessness, etc.). Homelessness may be documented in a variety of ways. Some examples include:
- Using the hospital city, state and zip code if a patient indicates they are homeless
- Using “General Delivery” with accompanying post office
- Recording HOMELESS in address field
- Recording NHA for address field and including hospital zip code
- Entering a specific/pre-designated value into zip code or other field (e.g., ZZZZZ)
- Indicator/checkbox for homeless
- Use of shelter address
We considered including the ICD code for inadequate housing (Z59.1) but ultimately chose to use a narrower definition.
(Z590 OR Z59.0 OR HOMELESS OR NO HOUSING OR LACK OF HOUSING OR WITHOUT HOUSING OR SHELTER)
ANDNOT(ANIMAL SHELTER OR DOMESTIC VIOLENCE SHELTER OR DV SHELTER OR DOG OR CAT)