Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study

Kushel, Margot; Perry, Sharon; Bangsberg, David R.; Clark, Richard A.; Moss, Andrew R.

doi:10.2105/ajph.92.5.778

Cited by 414 publications

(377 citation statements)

References 28 publications

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“…3 As in other studies, the majority of subjects in our study had Medicaid. 34 The high insurance rate in our cohort reflects both Massachusetts' history of insuring the homeless population and recent health care reform, which provides subsidized insurance for residents earning ≤300% of the federal poverty level.…”

Section: Discussionmentioning

confidence: 93%

Geriatric Syndromes in Older Homeless Adults

et al. 2011

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Section: Discussionmentioning

confidence: 93%

Geriatric Syndromes in Older Homeless Adults

et al. 2011

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“…33 We also considered pastyear physical or sexual assault while homeless, since victimized individuals appear to use health services at higher rates. 3,34 Substance abuse variables included illicit drug use or problem alcohol use in the preceding year. Past-year drug use was defined as any past-year use of illicit or nonprescribed controlled substances, or any past-year drug treatment.…”

Section: Main Predictormentioning

confidence: 99%

“…The definition for high ED use was derived from a prior survey of homeless and marginally housed individuals in which the 8% of respondents who used the ED four or more times in 1 year accounted for 55% of ED visits among those surveyed. 3 …”

Section: Main Outcome Measuresmentioning

confidence: 99%

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Food Insufficiency and Health Services Utilization in a National Sample of Homeless Adults

et al. 2011

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BACKGROUND:Homeless people have high rates of hospitalization and emergency department (ED) use. Obtaining adequate food is a common concern among homeless people and may influence health care utilization. OBJECTIVE: We tested the hypothesis that food insufficiency is related to higher rates of hospitalization and ED use in a national sample of homeless adults. DESIGN: We analyzed data from the 2003 Health Care for the Homeless (HCH) User Survey. PARTICIPANTS: Participants were 966 adults surveyed at 79 HCH clinic sites throughout the US. The study sample was representative of over 436,000 HCH clinic users nationally. MEASURES: We determined the prevalence and characteristics of food insufficiency among respondents. Using multivariable logistic regression, we examined the association between food insufficiency and four past-year acute health services utilization outcomes: (1) hospitalization for any reason, (2) psychiatric hospitalization, (3) any ED use, and (4) high ED use (≥4 visits). RESULTS: Overall, 25% of respondents reported food insufficiency. Among them, 68% went a whole day without eating in the past month. Chronically homeless (p = 0.01) and traumatically victimized (p = 0.001) respondents were more likely to be food insufficient. In multivariable analyses, food insufficiency was associated with significantly greater odds of hospitalization for any reason (AOR 1.59, 95% CI 1.07, 2.36), psychiatric hospitalization (AOR 3.12, 95% CI 1.73, 5.62), and high ED utilization (AOR 2.83, 95% CI 1.32, 6.08). CONCLUSIONS: One-fourth of homeless adults in this national survey were food insufficient, and this was associated with increased odds of acute health services utilization. Addressing the adverse health services utilization patterns of homeless adults will require attention to the social circumstances that may contribute to this issue.KEY WORDS: homelessness; food insufficiency; health services utilization.

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“…Among these high-risk populations are homeless veterans who have an age-adjusted mortality almost three times greater than their housed counterparts 2 and whose health care is often defined by use of high acuity services-over 40.4% went to an emergency department during a 12-month period 3 , lengthy hospitalizations averaging 4.1 days longer 4 and limited access and use of primary care, especially in the VA system 5 .…”

Section: Introductionmentioning

confidence: 99%

Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

et al. 2011

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Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based Study

Abstract: Efforts to reduce emergency department use among the homeless should be targeted toward addressing underlying risk factors among those exhibiting high rates of use.

Cited by 414 publications

References 28 publications

Geriatric Syndromes in Older Homeless Adults

Geriatric Syndromes in Older Homeless Adults

Food Insufficiency and Health Services Utilization in a National Sample of Homeless Adults

Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

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