Accuracy of Self-Reported Health Care Use in a Population-Based Sample of Homeless Adults


To assess the accuracy of self-reported ambulatory care visits, emergency department (ED) encounters, and overnight hospitalizations in a population-based sample of homeless adults.

Data Source

Self-report survey data and administrative health care utilization databases.

Study Design

Self-reported health care use in the past 12 months was compared to administrative encounter records among 1,163 homeless adults recruited in 2004–2005 from shelters and meal programs in Toronto, Ontario.

Data Extraction Methods

Self-reported health care use was assessed using a structured face-to-face survey. Each participant was linked to administrative databases using a unique personal health number or their first name, last name, sex, and date of birth.

Principal Findings

The sensitivity of self-report for ambulatory care visits, ED encounters, and overnight hospitalizations was 89, 80, and 73 percent, respectively; specificity was 37, 83, and 91 percent. The mean difference between self-reported and documented number of encounters in the past 12 months was +1.6 for ambulatory care visits (95 percent CI = 0.4, 2.8), −0.6 for ED encounters (95 percent CI = −0.8, −0.4), and 0.0 for hospitalizations (95 percent CI = 0.0, 0.1).


Adults experiencing homelessness are quite accurate reporters of their use of health care, especially for ED encounters and hospitalizations.

Publication Date: 
In press
Journal Name: 
Health Services Research
Toronto, ON, Canada