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Guest Blog: NYC Health + Hospitals on Homeless Patient Data Matching, Featured in HBR

05.24.2019

Harvard Business Review recently highlighted H+H’s work through an article co-authored by H+H’s Office of Population Health leads.

At New York City Health + Hospitals, which serves more than one million people a year, caring for homeless New Yorkers is a part of daily care delivery. Using data science to identify homeless patients through an accessible data dashboard helps H+H tailor their care and match patients to the right hospital and community-based supports — ultimately including housing itself. Harvard Business Review recently highlighted H+H’s work through an article co-authored by H+H’s Office of Population Health leads.

The article highlights H+H’s approach to building a dashboard through data mining and matching – no small feat considering that each of the one million patients have records that rest in H+H’s registration systems, clinical records, and insurance claims. These disparate systems were mined to create a composite definition of homelessness, including:

  • Matching addresses for each of our one million patients to homeless shelters and our own hospitals.
  • Searching for the words “homeless,” “undomiciled,” or “shelter” anywhere in the address fields.
  • Flagging patients whose home zip code changed 10 or more times in one year.
  • Pulling records with a “homeless” flag from registration at the few facilities that record this.
  • Searching for the diagnosis code for homelessness on the clinical problem list, other diagnostic assessments, or in the billing data.

The data review captured more than 20,000 adult homeless patients served by H+H within one year. A utilization analysis showed that homeless patients come to H+H disproportionately through the Emergency Department, have longer and more frequent hospital stays, and experience higher rates of behavioral health issues such as substance use, mood disorders, and schizophrenia. Homeless patients are nine times more likely to visit the ER or be admitted than our average patient. H+H opened an outpatient complex-care clinic at NYC Health + Hospitals/Bellevue, which has the largest number of homeless patients of the hospitals in the system. The clinic offers flexible walk-in appointments and longer visits, which are required to better address overlapping health and social needs. The clinic also has dedicated staff knowledgeable about the issues homeless patients struggle with, such as substance use disorder and the need for assistance navigating the public housing system.

Harvard Business Review's article is available here.

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