Background: To identify patients at the highest risk for acute care utilization, health care systems have developed “hot spotter” programs. Homelessness is a robust social determinant of acute care utilization. Objectives: To describe the prevalence, patterns, and correlates of meeting criteria for a hot spotter program among housing-insecure adults in the US Veterans Health Administration (VHA). Research Design: Among veterans on the VHA Homeless Registry in Fiscal Years 2018–2022 (N=1,469,893), we identified those who met criteria for a Hot Spotter Report ie, ≥1 hospital admissions and/or ≥2 emergency department (ED) visits in at least one quarter, described their patterns of acute care use, and examined differences in patient characteristics and outpatient service use between those who met report criteria in multiple quarters (vs. one). Results: Thirty percent (N=446,974) met report criteria in at least one quarter; most (56%) met report criteria in ≥2 quarters. Diagnoses of depression (58%) and/or a substance use disorder (51%) were common; however, the rate of hospitalization in an acute medical setting during the cohort period was twice that of being hospitalized in an acute mental health setting (50% vs. 25%). Being on the Hot Spotter Report in multiple quarters (vs. one) was associated with more chronic conditions (M=5.08 vs. 3.29), higher rates of suicidality (23.7% vs. 11.7%), and higher likelihood of all types of outpatient care ( P <0.0001). Conclusions: Given rates of chronic medical conditions and medical hospitalizations, it may behoove hot spotter programs to increase care coordination with medical respite programs to support patients in the postacute phase.
Blonigen et al. (Thu,) studied this question.