Mobile point-of-care testing to improve access to care for people experiencing homelessness and diabetes in Los Angeles.

OBJECTIVES

To evaluate the utilization and results of point-of-care (POC) testing performed by the UCLA Health Homeless Healthcare Collaborative (HHC) to identify diagnostic patterns in patients experiencing homelessness (PEH) and specifically those with diabetes to inform future care models.

METHODS

A retrospective cohort study was performed using electronic health records of PEH who visited HHC mobile units between January 2023 and August 2024. Point-of-care test quantity, timing, and results were assessed. A comprehensive metabolic panel (CMP), blood glucose, and hemoglobin A1c (HbA1c) results were assessed for differences between diabetic and nondiabetic cohorts at initial presentation.

RESULTS

Between January 2023 and August 2024, the HHC served 4653 patients, with 836 receiving a POC test (17.97%). During this period, 126 basic metabolic panels, 197 CMPs, 102 COVID-19 antigen tests, 533 glucose tests, 166 HbA1c tests, 87 hemoglobin tests, 80 influenza A and B tests, 22 rapid strep A tests, 119 urinalysis dipstick tests, and 41 urine pregnancy tests were used. Of all tested, 190 (22.73%) received a diabetes International Classification of Diseases code. Within CMP results, mean sodium (139.5 vs 141.1 mmol/L; P < .05) and mean chloride (103.7 vs 105.8 mmol/L; P < .05) were both lower in patients with diabetes. The mean creatinine was not significantly different (0.91 vs 1.06 mg/dL; P = .097).

CONCLUSIONS

Point-of-care testing provides critical diagnostic data for PEH, particularly those with diabetes, allowing for a clinician to initiate care prior to the development of severe disease. Expanding the test menu to include urinary albumin-to-creatinine ratio screening and creating POC-specific reference intervals is an opportunity for improvement.