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Hospital to Home

Triage Tool II for Identifying Homeless Hospital Patients in Crisis

November 18, 2012 / By Daniel Flaming, Patrick Burns, Gerald Sumner, Manuel H. Moreno and Halil Toros
Underwriter: Economic Roundtable

Different conditions of body and mind found among homeless adults provide a basis for predicting who will have very high public costs – in the 10th cost decile. This report presents a triage tool developed specifically for use in hospitals or clinics where there is not access to data from other agencies about the use of non-medical public services.

The tool equips hospitals and affiliated clinics to make credible requests to housing providers that high-need patients be given first priority for the scarce supply of affordable housing with supportive services.

The screening tool is predicting which homeless hospital patients will have high future costs based on total services from all public agencies, not just health care providers. Medical conditions provide partially reliable indicators of future encounters with non-medical agencies as well as strongly reliable indicators of future encounters with health care providers.

This triage tool is not as reliable as the other three 10th decile predictive screening tools developed by the Economic Roundtable because it relies solely on medical data. Nevertheless, the screening results it produces the tool makes correct determinations about 10th decile cost status 84 percent of the time.

The triage tool and the screening form for collecting data for the tool use ICD-9 medical diagnostic codes. The link below provides a crosswalk from ICD-9 to ICD-10 codes as well as lists of codes indicating  chronic medical conditions and substance abuse. The tool uses flags for both of these conditions.

The triage tool was developed for use in 17 hospitals in Los Angeles County. Screening and housing programs at these hospitals were developed in collaboration with the Corporation for Supportive Housing, through its Frequent Users Systems Engagement (FUSE) Program and through a Social Innovation Fund (SIF) grant from the Corporation for National and Community Service. Seven social service and housing navigation teams worked to house high-need patients from these hospitals.

The collaborative steps for screening and housing high-need homeless hospital patients are shown in this flow chart.

Area of Work: People
Tags: Behavioral Health, Chronic Homelessness, Cost Avoidance, Cost-Based Priority, Cost-Based Ranking, Disabilities, Economic Impacts, Health, Homelessness, Hospitals, Housing, Jails, Los Angeles, Los Angeles County, Permanent Supportive Housing, Poverty, Predictive Analytic Statistical Algorithm, Prevention, Public Costs, Risk, Screening, Service Integration, Social Safety Net, Triage Tool