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Two reference standard definitions of homelessness were adopted: the housing episode and the annual housing experience (any homelessness within a calendar year).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main outcome measures<\/jats:title>\n                    <jats:p>Sensitivity, specificity, positive and negative predictive values and positive likelihood ratios of 30 case ascertainment algorithms for detecting homelessness using up to eight health service databases.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Sensitivity estimates ranged from 10.8% to 28.9% (housing episode definition) and 18.5% to 35.6% (annual housing experience definition). Specificities exceeded 99% and positive likelihood ratios were high using both definitions. The most optimal algorithm estimates that 59\u2009974 (95% CI 55\u2009231 to 65 208) Ontarians (0.53% of the adult population) experienced homelessness in 2016, a 67.3% increase from 2007.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>In Ontario, case ascertainment algorithms for identifying homelessness had low sensitivity but very high specificity and positive likelihood ratio. The use of health administrative databases may offer opportunities to track individuals experiencing homelessness over time and inform efforts to improve housing and health status in this vulnerable population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2019-030221","type":"journal-article","created":{"date-parts":[[2019,10,8]],"date-time":"2019-10-08T07:25:45Z","timestamp":1570519545000},"page":"e030221","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":60,"title":["Validation study of health administrative data algorithms to identify individuals experiencing homelessness and estimate population prevalence of homelessness in Ontario, Canada"],"prefix":"10.1136","volume":"9","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-6577-5067","authenticated-orcid":false,"given":"Lucie","family":"Richard","sequence":"first","affiliation":[{"name":"ICES Western, Toronto, Ontario, Canada"},{"name":"MAP Centre for Urban Health Solutions, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen W","family":"Hwang","sequence":"additional","affiliation":[{"name":"St Michael's Hospital, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheryl","family":"Forchuk","sequence":"additional","affiliation":[{"name":"Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rosane","family":"Nisenbaum","sequence":"additional","affiliation":[{"name":"St Michael's Hospital, Toronto, Ontario, Canada"},{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kristin","family":"Clemens","sequence":"additional","affiliation":[{"name":"Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kathryn","family":"Wiens","sequence":"additional","affiliation":[{"name":"Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard","family":"Booth","sequence":"additional","affiliation":[{"name":"Arthur Labatt Family School of Nursing, Western University, London, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mahmoud","family":"Azimaee","sequence":"additional","affiliation":[{"name":"ICES, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salimah Z","family":"Shariff","sequence":"additional","affiliation":[{"name":"ICES Western, Toronto, Ontario, Canada"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2019,10,7]]},"reference":[{"key":"2025121509435958000_9.10.e030221.1","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations","volume":"384","author":"Fazel","year":"2014","journal-title":"The Lancet"},{"key":"2025121509435958000_9.10.e030221.2","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301369"},{"key":"2025121509435958000_9.10.e030221.3","doi-asserted-by":"publisher","DOI":"10.1177\/00027640121957051"},{"key":"2025121509435958000_9.10.e030221.4","doi-asserted-by":"publisher","DOI":"10.1016\/j.evalprogplan.2004.07.006"},{"key":"2025121509435958000_9.10.e030221.5","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1071\/PY99037","article-title":"Researching health and homelessness: methodological challenges for researchers working with a vulnerable, hard to reach, transient population","volume":"5","author":"Booth","year":"1999","journal-title":"Aust J Prim Health"},{"key":"2025121509435958000_9.10.e030221.6","unstructured":"Laflamme F . 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