Leaving before discharge from a homeless Medical Respite program: predisposing factors and impact on selected outcomes.

BACKGROUND: Medical Respite addresses care needs of homeless patients post-hospital discharge and is linked to reduced rehospitalization compared with standard discharge. However, outcomes may differ for Respite patients who exit before completing post-acute treatment and discharge plans. METHODS: Using administrative data from a San Francisco Medical Respite center (2007-2010), this retrospective study compares patient characteristics, post-Respite connections to community services, and likelihood of rehospitalization within 90 days of Respite exit between patients who choose to leave before discharge and all other Respite patients (logistic regression, odds ratio). FINDINGS: Of 860 encounters, 31% ended when patient chose to leave before discharge. Female gender (OR 1.65), living on the street immediately prior to Respite (OR 1.36) and substance use (OR 1.55) were associated with increased risk of leaving early. Patients who left early were more likely than others to decline referrals to services and more likely to be re-admitted within 90 days.

How health care setting affects prenatal providers' risk reduction practices: a qualitative comparison of settings.

BACKGROUND: We sought to understand how systemic factors might facilitate or impede providers' ability to screen for and intervene on prenatal behavioral risks. METHODS: We convened eight focus groups of 60 prenatal care providers to explore methods for assessing and counseling pregnant women about tobacco, alcohol, and illicit drug use. Because practice setting was often mentioned as either an inducement or barrier to risk prevention, we conducted a re-analysis of focus group transcripts to examine systemic factors. RESULTS: Practice setting strongly influenced providers' behavior, and settings differed by continuity of care, availability of resources, and organized support for risk prevention. The most striking contrasts were found between private practice and a large HMO. CONCLUSION: Each setting had features that facilitated prevention counseling. Understanding such systemic factors could lead to improved risk prevention practices during pregnancy across all health care settings.