Hard-to-Reach Populations and Administrative Health Data: A Serial Cross-sectional Study and Application of Data to Improve Interventions for People Experiencing Homelessness.

BACKGROUND: Intervention studies with vulnerable groups in the emergency department (ED) suffer from lower quality and an absence of administrative health data. We used administrative health data to identify and describe people experiencing homelessness who access EDs, characterize patterns of ED use relative to the general population, and apply findings to inform the design of a peer support program. METHODS: We conducted a serial cross-sectional study using administrative health data to examine ED use by people experiencing homelessness and nonhomeless individuals in the Niagara region of Ontario, Canada from April 1, 2010 to March 31, 2018. Outcomes included number of visits; unique patients; group proportions of Canadian Triage and Acuity Scale (CTAS) scores; time spent in emergency; and time to see an MD. Descriptive statistics were generated with t tests for point estimates and a Mann-Whitney U test for distributional measures. RESULTS: We included 1,486,699 ED visits. The number of unique people experiencing homelessness ranged from 91 in 2010 to 344 in 2017, trending higher over the study period compared with nonhomeless patients. Rate of visits increased from 1.7 to 2.8 per person. People experiencing homelessness presented later with higher overall acuity compared with the general population. Time in the ED and time to see an MD were greater among people experiencing homelessness. CONCLUSIONS: People experiencing homelessness demonstrate increasing visits, worse health, and longer time in the ED when compared with the general population, which may be a burden on both patients and the health care system.

Characterizing people experiencing homelessness and trends in homelessness using population-level emergency department visit data in Ontario, Canada.

BACKGROUND: Data on people experiencing homelessness often come from time- and labour-intensive cross-sectional counts and surveys from selected samples. This study uses comprehensive administrative health data from emergency department (ED) visits to enumerate people experiencing homelessness and characterize demographic and geographic trends in the province of Ontario, Canada, from 2010 to 2017. DATA AND METHODS: People experiencing homelessness were identified by their postal code, designated as "XX." Outcomes included the number of people experiencing homelessness stratified by year and week, gender and age plotted annually, the location of each ED visit, and composition changes in demographics and geographic distribution. RESULTS: Over seven years, 39,408 individuals were identified as experiencing homelessness. The number of ED visits increased over the study period in all of Ontario. The average peak in the number of visits occurred annually in September, with the fewest visits in January. Rises in overall homelessness were secondary to increases in working-age homelessness. ED presentations were concentrated in urban centres. The total proportion of patients experiencing homelessness became less concentrated in Toronto, decreasing from 60% to 40% over the study period, with a shift toward EDs outside the city. DISCUSSION: This study shows that administrative health data can provide comprehensive information on demographics and other characteristics analyzed over time. Surveillance can be conducted cost-effectively, and changes can be tracked in real time to allow for services to be coordinated and implemented in a time-sensitive manner.

Characteristics of Children with Diabetic Ketoacidosis Treated in Pediatric Intensive Care Unit: Two-Center Cross-Sectional Study in Croatia.

Background and objective: There is an increasing risk of type 1 diabetes mellitus (T1D) among children in Croatia. Diabetic ketoacidosis (DKA) is the leading cause of morbidity and mortality in children with T1D, with cerebral edema as the most severe complication. Since early recognition of cerebral edema leads to a better outcome, it is important that patients with moderate or severe DKA are closely monitored and treated in pediatric intensive care units (PICUs). The aim of this study is to investigate clinical and laboratory parameters, as well as complications in children treated in PICUs because of DKA. Materials and methods: Patients treated due to DKA in the PICU of the University Hospitals of Split and Osijek from 2013 to 2017 were included in this study. Retrospectively collected data included age, gender, clinical signs and symptoms, and various laboratory parameters. After dividing subjects into two groups: Newly diagnosed with T1D (NT1D) and previously diagnosed with T1D (PT1D), collected data were compared between the two groups. Results: A total of 82 patients were enrolled. Those with NT1D were more often treated in the PICU, with two of them developing cerebral edema. Dehydration was the most frequent clinical sign, found in 95% of patients at admission. Decreased consciousness level was found in 41.5% of patients, with majority of them being somnolent. No difference was found between NT1D and PT1D. Additionally, there was no significant difference regarding laboratory data at admission. Conclusions: More children with NT1D required treatment in the PICU due to DKA with two of them developing cerebral edema. Since cerebral edema is a life-threatening condition, treatment of patients with moderate or severe DKA in PICUs will provide necessary monitoring enabling early recognition, treatment, and better treatment outcome. To minimize the incidence of DKA among patients with NT1D, it is important to continuously carry out public health education programs aimed at early identification of signs and symptoms of T1D.