Comparing Homeless and Domiciled Patients’ Utilization of the Harris County, Texas Public Hospital System

Abstract

Homeless individuals have mortality rates three to six times higher than their housed counterparts and have elevated rates of mental illness, substance abuse, and co-morbidities that increase their need for health services. Data on the utilization of Harris County, Texas' public hospital system by 331 homeless individuals and a random sample of 17,824 domiciled patients were obtained from June 2008 to July 2009. Homeless individuals had increased readmission rates, especially within 30 days of discharge, resulting in significantly higher total annual length of stay. Homeless patients also more frequently utilize public hospitals for mental illness and HIV. Lack of community health services contributes to an increased dependence and preventable over-utilization of public hospital systems. Case management interventions integrating primary and behavioral care into health homes, medical respite programs, and training for health care professionals who provide indigent care will improve health outcomes of this population and reduce costs.

Mobile Nurse Practitioner: A Pilot Program to Address Service Gaps Experienced by Homeless Individuals

“…They are often stigmatized and viewed as unproductive members of society, relying on the system for care. High-risk users of the health care system, those who give rise to what is known as the revolving door phenomenon, frequently present in emergency departments due to lack of support systems in their communities (Buck et al, 2012).…”

“…They have a higher rate of dual diagnosis, living with coexisting mental illness and substance abuse, which further complicates their treatment needs (Buck et al, 2012). Poor discharge planning, lack of coordinated inpatient and outpatient services, and mental illness are all risk factors that increase the probability of hospital readmission.…”

“…Poor discharge planning, lack of coordinated inpatient and outpatient services, and mental illness are all risk factors that increase the probability of hospital readmission. The lack of infrastructure and limited available programs increases homeless individuals' lengths of stay, contributes to higher mortality rates, and imposes higher costs to health care organizations compared to the general population (Buck et al, 2012).…”

“…Respite programs and home health models have drawn attention away from focusing on infrastructures and directed energy to the community settings where integrated primary and behavioral care can be provided to individuals who are homeless (Buck et al, 2012). Home health models focus on bringing services to individuals in their community settings.…”

“…n the United States, the number of homeless individuals is estimated to range between 2.3 to 3.5 million, with many of these individuals experiencing chronic medical and mental illnesses (Buck, Brown, Mortensen, Riggs, & Franzini, 2012). American health care continues to be one of the most expensive commodities in the United States, accounting for 17.9% of its gross domestic product in 2011 (Ferrier, Leleu, Moises, & Valdmanis, 2013).…”