Change in address in electronic health records as an early marker of homelessness

Janet Song; Yu Deng; Yuyang Yang; Lacey Gleason; Abel Kho

doi:10.1371/journal.pone.0318552

Peer Review History

Original SubmissionJune 3, 2024
3 Jun 2024 Author Response https://doi.org/10.1371/journal.pone.0318552.r001
25 Jun 2024 Decision Letter - Asadullah Shaikh, Editor PONE-D-24-20931Change in Address in Electronic Health Records as an Early Marker of HomelessnessPLOS ONE Dear Dr. Song, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Aug 09 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Asadullah Shaikh, Ph.D. Academic Editor PLOS ONE Journal Requirements: When submitting your revision, we need you to address these additional requirements. 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf 2. Thank you for stating the following in the Competing Interests section: "I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr. Abel Kho is an advisor for Datavant." Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. 3. We note that you have indicated that there are restrictions to data sharing for this study. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a) If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b) If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. We will update your Data Availability statement on your behalf to reflect the information you provide. 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #1: Yes Reviewer #2: Yes ******** 2. Has the statistical analysis been performed appropriately and rigorously? Reviewer #1: Yes Reviewer #2: Yes ****** 3. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #1: Yes Reviewer #2: No ****** 4. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #1: Yes Reviewer #2: Yes ****** 5. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #1: REVIEWER’s REPORT On the paper PONE-D-24-20931 Change in Address in Electronic Health Records as an Early Marker of Homelessness by Janet Song, Yu Deng, Yuyang Yang, Lacey Gleason, Abel Kho, In this paper the authors make a single-center cross-sectional study of EHR data (2018-2024) conducted at a US academic center with eleven sites across Chicago, including patients 18 years or older with at least three hospital encounters over three different years. The authors define address churn as the number of address changes recorded in the EHR corrected to three-year intervals and compare demographic and clinical characteristics of individuals with varying address churn, performing multivariable logistic regression to measure the association between people with a record of homelessness and address changes. The results are new, correct and detailed. The paper is original and doesn’t contradict to ethical or policy issues, the question posed by authors is new and well defined, the methods used by authors are appropriate and well described, the data are sound and well controlled, the discussion and conclusions are well balanced, the title and abstract convey the obtained results, the writing is acceptable, the paper contains good scientific results. The paper doesn’t require a revision. Taking the above into consideration, I recommend the paper for publication, in PLOS ONE. 9.06.2024 Reviewer #2: ABSTRACT: The abstract is clear but briefly mentioning the statistical methods used will further enhance clarity. Also add a brief statement on the impact of the findings on public health or clinical practice LITERATURE REVIEW: A section on Literature review is necessary. Though the Introduction is a bit clear about the context but it will be better to strengthen it with a more thorough review of existing literature on the use of EHR data for screening social determinants of health, and identifying gaps in previous studies. Conclude the section by highlighting the gap(s) that your study is addressing in clearer terms. Clearly state research questions or hypotheses at the end of the Introduction section. This will help frame the subsequent sections and guide the reader. METHODS: Ensure the study design is explicitly stated as cross-sectional and clarify why this design is appropriate for your research questions. Provide more details about the Electronic Data Warehouse (EDW), such as its scope, the types of data it includes, and any limitations. Do a brief description of USPS Postal Addressing Standards and its process more explicitly and explain how it is good for your study. Detail the consultation with housing workgroup experts and any validation of the ICD-10 codes and address records used to identify homelessness. Consider adding specific statistical tests of stated hypotheses and how they help address the research questions. Also add a section on possible confounding variables and how you handled them. RESULTS & DISCUSSIONS: The results section presents a lot of data but could be better structured with the view to helping the readers understand the context. You should clearly indicate which results are statistically significant and discuss the clinical relevance of these findings. Do a detailed interpretation of key findings of the research. Discuss how these findings compare to previous studies and what they add to the existing knowledge. Explain the potential biases and the generalizability of the findings, and any assumptions made during the analysis. CONCLUSION: Summarize your key findings more explicitly and discuss their implications for healthcare practice and policy. Furthermore, discuss the actions that healthcare sectors, clinicians, and policymakers will need to take to strengthen the integration of housing stability screening in healthcare systems. REFERENCES: Ensure all references are up-to-date and relevant. You will need to add more recent studies that are very relevant to your research. LANGUAGE: Make sure that the manuscript is free of grammatical errors and follow a consistent style of writing. I advise you engage use of language editor. Also ensure each section flows logically into the next, with clear connections between the research question, methods, results, and discussion. ****** 6. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #1: Yes: Alina Alb Lupas Reviewer #2: Yes: Boluwaji Ade Akinnuwesi ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0318552.r002
Revision 1
2 Aug 2024 Author Response Our point-by-point response to reviewers and editors are typed out below and uploaded as a document labeled "Response to Reviewers". Response to Reviewer #1 In this paper the authors make a single-center cross-sectional study of EHR data (2018-2024) conducted at a US academic center with eleven sites across Chicago, including patients 18 years or older with at least three hospital encounters over three different years. The authors define address churn as the number of address changes recorded in the EHR corrected to three-year intervals and compare demographic and clinical characteristics of individuals with varying address churn, performing multivariable logistic regression to measure the association between people with a record of homelessness and address changes. The results are new, correct and detailed. The paper is original and doesn’t contradict to ethical or policy issues, the question posed by authors is new and well defined, the methods used by authors are appropriate and well described, the data are sound and well controlled, the discussion and conclusions are well balanced, the title and abstract convey the obtained results, the writing is acceptable, the paper contains good scientific results. The paper doesn’t require a revision. Taking the above into consideration, I recommend the paper for publication, in PLOS ONE. Thank you for your thorough and positive review of our manuscript. We are delighted to hear that you found our study to be original, well-defined, and methodologically sound. We appreciate your recognition of the novelty and detail of our results, as well as your acknowledgment of the balanced discussion and conclusions. We are grateful for your recommendation for publication in PLOS ONE and are excited about the opportunity to contribute to the scientific community through this platform. Response to Reviewer #2 Thank you for your detailed and constructive review of our manuscript. We appreciate your feedback and insightful suggestions. Your comments have provided valuable guidance for enhancing the clarity and comprehensiveness of our paper. We will address each of your points in detail to ensure that our manuscript meets the highest standards of quality and rigor. ABSTRACT: The abstract is clear but briefly mentioning the statistical methods used will further enhance clarity. Also add a brief statement on the impact of the findings on public health or clinical practice. We added a statement mentioning the statistical methods (lines 30-34) and a statement on the impact of our findings on public health to our abstract (lines 48-50). Lines 30-34: “We compare demographic and clinical characteristics of individuals with varying address churn with the student T-test to look at distribution of address churn for patients with and without record of homelessness, ANOVA to evaluate the distribution of ages for different levels of churn, and the chi-square test to evaluate for association between churn and clinical diagnoses.” Lines 48-50: “Our findings can help public health policy makers in targeting vulnerable populations at risk of homelessness with multiple health comorbidities for interventions such as housing first.” LITERATURE REVIEW: A section on Literature review is necessary. Though the Introduction is a bit clear about the context but it will be better to strengthen it with a more thorough review of existing literature on the use of EHR data for screening social determinants of health, and identifying gaps in previous studies. Conclude the section by highlighting the gap(s) that your study is addressing in clearer terms. Clearly state research questions or hypotheses at the end of the Introduction section. This will help frame the subsequent sections and guide the reader. We added 9 additional references regarding the usage of EHR data for screening of social determinants of health from 2023 and 2024 for a more thorough and updated literature review. Throughout the paragraph we highlight pitfalls of existing methods of EHR screening and conclude the paragraph by summarizing the gap our study is addressing (lines 69-93). We have added our main hypothesis and research questions to the last paragraph of our Introduction (lines 94-104). METHODS: Ensure the study design is explicitly stated as cross-sectional and clarify why this design is appropriate for your research questions. Provide more details about the Electronic Data Warehouse (EDW), such as its scope, the types of data it includes, and any limitations. Do a brief description of USPS Postal Addressing Standards and its process more explicitly and explain how it is good for your study. Detail the consultation with housing workgroup experts and any validation of the ICD-10 codes and address records used to identify homelessness. Consider adding specific statistical tests of stated hypotheses and how they help address the research questions. Also add a section on possible confounding variables and how you handled them. We added a sentence explicitly stating the study is cross-sectional and why it is appropriate (lines 107-108). Lines 107-108: “We utilize a retrospective cross-sectional study design to get a baseline snapshot of address churn…” We have provided more details about the Electronic Data Warehouse (EDW), including its scope, and the types of data it includes (Lines 109-114). We have included limitations in the Limitations section under the Discussion (Lines 379-381). Lines 109-114: “The NM-EDW is a data repository that includes clinical and research data from sites within Northwestern University School of Medicine and Northwestern Medicine Healthcare (NMHC) for greater than 10 million patients spanning from 1970 to the present. It contains demographic data (age, gender, race, address), clinical data (diagnoses, medications, encounters, procedures), and outcomes extracted from the Northwestern Medicine EHR.” We added in the Methods section a description of USPS Postal Addressing standards, the process of capitalizing addresses and mapping spelling variations to standards, and how it helped cut down on redundant addresses for more accurate measurements (lines 133-142). We added a description of the collaboration with housing workgroup experts to develop set of criteria to find patients with record of homelessness. We also explained our validation with chart review and how we narrowed our criteria (lines 144-161). We have clarified how the statistical tests helped address each hypothesis and research question (lines 173-184, lines 214-215, and lines 223-228). We have added a section on possible confounding variables above the Statistical Analysis section (lines 205-212). RESULTS & DISCUSSIONS: The results section presents a lot of data but could be better structured with the view to helping the readers understand the context. You should clearly indicate which results are statistically significant and discuss the clinical relevance of these findings. Do a detailed interpretation of key findings of the research. Discuss how these findings compare to previous studies and what they add to the existing knowledge. Explain the potential biases and the generalizability of the findings, and any assumptions made during the analysis. We have clarified the results section by explaining how each result is a response to our hypothesis and research questions to provide more context to the readers (lines 231, 247, 268). We have included asterisks in Table 2 for statistically significant results and have ensured that results that were statistically significant presented in the text were also emphasized. We added a more detailed interpretation of key findings and how these compare to previous studies and that we are adding to existing knowledge a new variable for SDOH screening that has not previously been considered. (lines 305-372). We reorganized the limitations section to make it more clearly structured in addressing potential biases, generalizability, and assumptions (lines 373-399). CONCLUSION: Summarize your key findings more explicitly and discuss their implications for healthcare practice and policy. Furthermore, discuss the actions that healthcare sectors, clinicians, and policymakers will need to take to strengthen the integration of housing stability screening in healthcare systems. We have added to the Conclusion section by more explicitly stating our key findings and their implications for healthcare practice and policy. We added how clinicians and policy makers can strengthen the integration of housing stability screening to the end of the conclusion section (lines 401-416). REFERENCES: Ensure all references are up-to-date and relevant. You will need to add more recent studies that are very relevant to your research. We reviewed our references ensuring they are up-to-date and relevant. We added 17 additional references from 2023-2024 that are relevant to our research. LANGUAGE: Make sure that the manuscript is free of grammatical errors and follow a consistent style of writing. I advise you engage use of language editor. Also ensure each section flows logically into the next, with clear connections between the research question, methods, results, and discussion. We reviewed our manuscript several times to ensure it is free of grammatical errors, follows a consistent style of writing, and clear connections between the different sections. We used Microsoft Editor, a language editor built into Microsoft Word. Additional Requirements 1. Please ensure that your manuscript meets PLOS ONE's style requirements, including those for file naming. The PLOS ONE style templates can be found at : https://journals.plos.org/plosone/s/file?id=wjVg/PLOSOne_formatting_sample_main_body.pdf and https://journals.plos.org/plosone/s/file?id=ba62/PLOSOne_formatting_sample_title_authors_affiliations.pdf We have updated the title page of our manuscript to fit with PLOS ONE’s style requirements: Article title written in sentence case, numeric author affiliations in order, titles removed from author byline, removal of abbreviation from affiliations, removal of physical address for corresponding author, and inclusion of corresponding author’s initials. We have updated the main body of our manuscript formatting to fit with PLOS ONE’s style requirements with the following: use of level 1 heading for all major sections, use of level 2 heading for sub-sections, use of sentence case for all headings, brackets for in-text citations, and references updated per PLOS ONE format. 2. Thank you for stating the following in the Competing Interests section: "I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr. Abel Kho is an advisor for Datavant." Please confirm that this does not alter your adherence to all PLOS ONE policies on sharing data and materials, by including the following statement: "This does not alter our adherence to PLOS ONE policies on sharing data and materials.” (as detailed online in our guide for authors http://journals.plos.org/plosone/s/competing-interests). If there are restrictions on sharing of data and/or materials, please state these. Please note that we cannot proceed with consideration of your article until this information has been declared. Please include your updated Competing Interests statement in your cover letter; we will change the online submission form on your behalf. We have updated our Competing Interests statement to clarify that current conflicts of interest do not alter adherence to PLOS ONE policies and included it in the cover letter worded as below: “I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr. Abel Kho is an advisor for Datavant. This does not alter our adherence to PLOS ONE policies on sharing data and materials." 3. We note that you have indicated that there are restrictions to data sharing for this study. PLOS only allows data to be available upon request if there are legal or ethical restrictions on sharing data publicly. For more information on unacceptable data access restrictions, please see http://journals.plos.org/plosone/s/data-availability#loc-unacceptable-data-access-restrictions. Before we proceed with your manuscript, please address the following prompts: a. If there are ethical or legal restrictions on sharing a de-identified data set, please explain them in detail (e.g., data contain potentially identifying or sensitive patient information, data are owned by a third-party organization, etc.) and who has imposed them (e.g., a Research Ethics Committee or Institutional Review Board, etc.). Please also provide contact information for a data access committee, ethics committee, or other institutional body to which data requests may be sent. b. If there are no restrictions, please upload the minimal anonymized data set necessary to replicate your study findings to a stable, public repository and provide us with the relevant URLs, DOIs, or accession numbers. For a list of recommended repositories, please see https://journals.plos.org/plosone/s/recommended-repositories. You also have the option of uploading the data as Supporting Information files, but we would recommend depositing data directly to a data repository if possible. We will update your Data Availability statement on your behalf to reflect the information you provide. We have clarified our data sharing statement, that data contains potentially identifying patient information, and that data are accessible through the Northwestern Medicine Enterprise Data Warehouse with contact information worded as below. We also include the Northwestern Medicine Enterprise Data Warehouse in acknowledgements. “Data cannot be shared publicly due to legal restrictions as data contain potentially identifying patient information. Data are available from the Northwestern University Northwestern Medicine Enterprise Data Warehouse (NMEDW) (contact via fsm-research@northwestern.edu) for researchers who meet the criteria for access to confidential data.” 4. Please include your full ethics statement in the ‘Methods’ section of your manuscript file. In your statement, please include the full name of the IRB or ethics committee who approved or waived your study, as well as whether or not you obtained informed written or verbal consent. If consent was waived for your study, please include this information in your statement as well. We have updated the “Methods” section of our manuscript to include our full ethics statement to include the full name of the IRB who approved our study and that we obtained waiver of informed written or verbal consent (lines 124-128). “The study protocol was approved by the Northwestern University Institutional Review Board. Waiver of informed consent was obtained for this study because the research involved no more than minimal risk to patients as this study uses pre-existing data, the waiver will not adversely affect the rights and welfare of participants, and it would not be practicable to carry out the research without the waiver.” https://doi.org/10.1371/journal.pone.0318552.r003
27 Sep 2024 Decision Letter - Asadullah Shaikh, Editor PONE-D-24-20931R1Change in Address in Electronic Health Records as an Early Marker of HomelessnessPLOS ONE Dear Dr. Song, Thank you for submitting your manuscript to PLOS ONE. After careful consideration, we feel that it has merit but does not fully meet PLOS ONE’s publication criteria as it currently stands. Therefore, we invite you to submit a revised version of the manuscript that addresses the points raised during the review process. Please submit your revised manuscript by Nov 11 2024 11:59PM. If you will need more time than this to complete your revisions, please reply to this message or contact the journal office at plosone@plos.org . When you're ready to submit your revision, log on to https://www.editorialmanager.com/pone/ and select the 'Submissions Needing Revision' folder to locate your manuscript file. Please include the following items when submitting your revised manuscript: A rebuttal letter that responds to each point raised by the academic editor and reviewer(s). You should upload this letter as a separate file labeled 'Response to Reviewers'. A marked-up copy of your manuscript that highlights changes made to the original version. You should upload this as a separate file labeled 'Revised Manuscript with Track Changes'. An unmarked version of your revised paper without tracked changes. You should upload this as a separate file labeled 'Manuscript'. If you would like to make changes to your financial disclosure, please include your updated statement in your cover letter. Guidelines for resubmitting your figure files are available below the reviewer comments at the end of this letter. If applicable, we recommend that you deposit your laboratory protocols in protocols.io to enhance the reproducibility of your results. Protocols.io assigns your protocol its own identifier (DOI) so that it can be cited independently in the future. For instructions see: https://journals.plos.org/plosone/s/submission-guidelines#loc-laboratory-protocols . Additionally, PLOS ONE offers an option for publishing peer-reviewed Lab Protocol articles, which describe protocols hosted on protocols.io. Read more information on sharing protocols at https://plos.org/protocols?utm_medium=editorial-email&utm_source=authorletters&utm_campaign=protocols . We look forward to receiving your revised manuscript. Kind regards, Asadullah Shaikh, Ph.D. Academic Editor PLOS ONE [Note: HTML markup is below. Please do not edit.] Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #3: All comments have been addressed Reviewer #4: (No Response) Reviewer #5: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #3: Yes Reviewer #4: Partly Reviewer #5: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #3: Yes Reviewer #4: No Reviewer #5: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #3: No Reviewer #4: No Reviewer #5: (No Response) ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #3: Yes Reviewer #4: No Reviewer #5: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #3: (No Response) Reviewer #4: Inadequate Introduction: Introduction should include proper background of the research area and research topic as well as the works from state of the arts. Graphics and Visual Aids: All of the figures and tables in the manuscript could be enhanced for clarity and better understanding. Formatting and Structure: There are many inconsistencies in the formatting and structure of the manuscript that could be streamlined for a more professional presentation. Authors uses the same heading two times. “Diagnosis data” line 224 and “Diagnoses” in line 307 Related works section missing In overall, this manuscript looks like a technical web report Reviewer #5: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #3: No Reviewer #4: Yes: Awais Ahmad Reviewer #5: Yes: Muhammad Ahmad Pasha ******** [NOTE: If reviewer comments were submitted as an attachment file, they will be attached to this email and accessible via the submission site. Please log into your account, locate the manuscript record, and check for the action link "View Attachments". If this link does not appear, there are no attachment files.] While revising your submission, please upload your figure files to the Preflight Analysis and Conversion Engine (PACE) digital diagnostic tool, https://pacev2.apexcovantage.com/ . PACE helps ensure that figures meet PLOS requirements. To use PACE, you must first register as a user. Registration is free. Then, login and navigate to the UPLOAD tab, where you will find detailed instructions on how to use the tool. If you encounter any issues or have any questions when using PACE, please email PLOS at figures@plos.org . Please note that Supporting Information files do not need this step. https://doi.org/10.1371/journal.pone.0318552.r004
Revision 2
6 Nov 2024 Author Response 1. Inadequate Introduction Reviewer Comment: Introduction should include proper background of the research area and research topic as well as the works from state of the arts. Response: Thank you for your feedback. We have revised the introduction to provide a more comprehensive background of the research area and topic. Specifically, we provided a broader historical context for our research topic and incorporated state of the art of general homelessness research in lines 55-58 and lines 62-72, respectively. Please see the related works section to get a more comprehensive literature review of housing screening in electronic health records. 2. Graphics and Visual Aids Reviewer Comment: All of the figures and tables in the manuscript could be enhanced for clarity and better understanding. Response: We appreciate your suggestion. We have reviewed our figures and processed them through PACE to best adhere to PLOSOne publication standards. We also encourage you to click the links in the PDFs as the figures in the PDF have lower resolution than the actual image accessed through the link. Tables have been reviewed to ensure numbers are clear and accurate. 3. Formatting and Structure Reviewer Comment: There are many inconsistencies in the formatting and structure of the manuscript that could be streamlined for a more professional presentation. Authors uses the same heading two times. “Diagnosis data” line 224 and “Diagnoses” in line 307. Response: Thank you for bringing this point of confusion to our attention. We have thoroughly reviewed and corrected the formatting and structure of the manuscript. The headings have been adjusted so the reader may better understand the content contained within each header. In line 203 we have changed “Diagnosis data” to be “Processing diagnosis data” to clarify that we are discussing our methodology of how we processed the diagnosis data. In line 262, we have changed the header from “Diagnoses” to “Diagnostic characteristics of address churn” to clarify that these are the results of our analyses looking at proportions of diagnoses per address churn group as displayed in Figure 2 and looking at top ten most frequent diagnoses per group. This header now parallels the preceding header in line 246, “Demographic characteristics of churn”. We have additionally included headers in the discussion section to help guide readers (lines 310, 323, 344, 366, 385, and 394). We also restructured the discussion section to better convey our main findings how they support our hypothesis. With the exception of the “Association between address churn and homelessness” section, we have also reordered the discussion section to better parallel the order of the results section in lines 324-344. We hope these changes help with making the overall presentation streamlined for a more professional appearance. 4. Related Works Section Missing Reviewer Comment: Related works section missing. Response: Thank you for your feedback, while there is not a separate related works section, we have a detailed review of related works already included in the introduction. We now include a heading in our paper highlighting the “Related works” section to improve the clarity. The introduction has been edited as discussed in item 1 “Inadequate Introduction” so that it includes a broader overview on the research matter and the relevant related works on housing screening is in a separate “Related works” section on lines 80-107. 5. Overall Presentation Reviewer Comment: In overall, this manuscript looks like a technical web report. Response: We appreciate your candid feedback. We have made significant revisions as detailed above to ensure that the manuscript adheres to academic standards and does not resemble a technical web report. These changes include improving the narrative flow, enhancing the academic tone, and ensuring consistency in formatting and style. Attachments Attachment Submitted filename: Response to reviewers.docx https://doi.org/10.1371/journal.pone.0318552.r005
20 Jan 2025 Decision Letter - Asadullah Shaikh, Editor Change in Address in Electronic Health Records as an Early Marker of Homelessness PONE-D-24-20931R2 Dear Dr. Song, We’re pleased to inform you that your manuscript has been judged scientifically suitable for publication and will be formally accepted for publication once it meets all outstanding technical requirements. Within one week, you’ll receive an e-mail detailing the required amendments. When these have been addressed, you’ll receive a formal acceptance letter and your manuscript will be scheduled for publication. An invoice will be generated when your article is formally accepted. Please note, if your institution has a publishing partnership with PLOS and your article meets the relevant criteria, all or part of your publication costs will be covered. Please make sure your user information is up-to-date by logging into Editorial Manager at Editorial Manager® and clicking the ‘Update My Information' link at the top of the page. If you have any questions relating to publication charges, please contact our Author Billing department directly at authorbilling@plos.org. If your institution or institutions have a press office, please notify them about your upcoming paper to help maximize its impact. If they’ll be preparing press materials, please inform our press team as soon as possible -- no later than 48 hours after receiving the formal acceptance. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. Kind regards, Asadullah Shaikh, Ph.D. Academic Editor PLOS ONE Additional Editor Comments (optional): Reviewers' comments: Reviewer's Responses to Questions Comments to the Author 1. If the authors have adequately addressed your comments raised in a previous round of review and you feel that this manuscript is now acceptable for publication, you may indicate that here to bypass the “Comments to the Author” section, enter your conflict of interest statement in the “Confidential to Editor” section, and submit your "Accept" recommendation. Reviewer #4: All comments have been addressed Reviewer #6: All comments have been addressed ******** 2. Is the manuscript technically sound, and do the data support the conclusions? The manuscript must describe a technically sound piece of scientific research with data that supports the conclusions. Experiments must have been conducted rigorously, with appropriate controls, replication, and sample sizes. The conclusions must be drawn appropriately based on the data presented. Reviewer #4: Yes Reviewer #6: Yes ****** 3. Has the statistical analysis been performed appropriately and rigorously? Reviewer #4: Yes Reviewer #6: Yes ****** 4. Have the authors made all data underlying the findings in their manuscript fully available? The PLOS Data policy requires authors to make all data underlying the findings described in their manuscript fully available without restriction, with rare exception (please refer to the Data Availability Statement in the manuscript PDF file). The data should be provided as part of the manuscript or its supporting information, or deposited to a public repository. For example, in addition to summary statistics, the data points behind means, medians and variance measures should be available. If there are restrictions on publicly sharing data—e.g. participant privacy or use of data from a third party—those must be specified. Reviewer #4: No Reviewer #6: Yes ****** 5. Is the manuscript presented in an intelligible fashion and written in standard English? PLOS ONE does not copyedit accepted manuscripts, so the language in submitted articles must be clear, correct, and unambiguous. Any typographical or grammatical errors should be corrected at revision, so please note any specific errors here. Reviewer #4: No Reviewer #6: Yes ****** 6. Review Comments to the Author Please use the space provided to explain your answers to the questions above. You may also include additional comments for the author, including concerns about dual publication, research ethics, or publication ethics. (Please upload your review as an attachment if it exceeds 20,000 characters) Reviewer #4: I am satisfied with the answers of the raised comments....................................................................................................................................................................................................................................................................................................................................... Reviewer #6: (No Response) ****** 7. PLOS authors have the option to publish the peer review history of their article (what does this mean? ). If published, this will include your full peer review and any attached files. If you choose “no”, your identity will remain anonymous but your review may still be made public. Do you want your identity to be public for this peer review? For information about this choice, including consent withdrawal, please see our Privacy Policy . Reviewer #4: Yes: Awais Ahmad Reviewer #6: No ******** https://doi.org/10.1371/journal.pone.0318552.r006
Formally Accepted
Acceptance Letter - Asadullah Shaikh, Editor PONE-D-24-20931R2 PLOS ONE Dear Dr. Song, I'm pleased to inform you that your manuscript has been deemed suitable for publication in PLOS ONE. Congratulations! Your manuscript is now being handed over to our production team. At this stage, our production department will prepare your paper for publication. This includes ensuring the following: * All references, tables, and figures are properly cited * All relevant supporting information is included in the manuscript submission, * There are no issues that prevent the paper from being properly typeset If revisions are needed, the production department will contact you directly to resolve them. If no revisions are needed, you will receive an email when the publication date has been set. At this time, we do not offer pre-publication proofs to authors during production of the accepted work. Please keep in mind that we are working through a large volume of accepted articles, so please give us a few weeks to review your paper and let you know the next and final steps. Lastly, if your institution or institutions have a press office, please let them know about your upcoming paper now to help maximize its impact. If they'll be preparing press materials, please inform our press team within the next 48 hours. Your manuscript will remain under strict press embargo until 2 pm Eastern Time on the date of publication. For more information, please contact onepress@plos.org. If we can help with anything else, please email us at customercare@plos.org. Thank you for submitting your work to PLOS ONE and supporting open access. Kind regards, PLOS ONE Editorial Office Staff on behalf of Prof. Asadullah Shaikh Academic Editor PLOS ONE Attachments Attachment Submitted filename: pone.0318552.docx https://doi.org/10.1371/journal.pone.0318552.r007

Open letter on the publication of peer review reports

PLOS recognizes the benefits of transparency in the peer review process. Therefore, we enable the publication of all of the content of peer review and author responses alongside final, published articles. Reviewers remain anonymous, unless they choose to reveal their names.

We encourage other journals to join us in this initiative. We hope that our action inspires the community, including researchers, research funders, and research institutions, to recognize the benefits of published peer review reports for all parts of the research system.

Learn more at ASAPbio .