Hospitalization Costs Associated with Homelessness in New York City

Salit, Sharon A.; Kuhn, Evelyn M.; Hartz, Arthur J.; Vu, Jade M.; Mosso, Andrew L.

doi:10.1056/nejm199806113382406

Cited by 275 publications

(218 citation statements)

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“…37,41 In this study, poor health status and the presence of mental health problems were strong predictors of medical/surgical and psychiatric hospitalizations, respectively. The findings also suggest that many of these hospitalizations are potentially avoidable, particularly for medical/surgical hospitalizations where the largest number of diagnoses could be attributed to injuries, poisonings, and other external causes.…”

Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

“…These findings are consistent with previous research that suggests that substance abuse and mental illness together account for the majority of hospitalizations among homeless persons. 37,38 Hospitalizations due to substance abuse and mental illness as well as preventable conditions such as injuries, poisonings, and other circumstances of external causes comprised the primary reasons for medical/surgical and psychiatric hospitalization in this study.Current smoking status was also associated with an increased likelihood of psychiatric hospitalization, a somewhat surprising finding, but one that may indicate that substance use is a coping mechanism for mental health problems. The extremely high smoking rates among study participants (>70%) is notable, given that only 17% of Canadians report being current smokers.…”

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confidence: 99%

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Predictors of Medical or Surgical and Psychiatric Hospitalizations Among a Population-Based Cohort of Homeless Adults

et al. 2013

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Objectives-To identify factors associated with inpatient hospitalizations among a populationbased cohort of homeless adults in Toronto, Canada. Human Participant ProtectionThis study was approved by the Research Ethics Board at St. Michael's Hospital in Toronto, Canada. All participants provided written informed consent. NIH Public Access Author ManuscriptAm J Public Health. Author manuscript; available in PMC 2014 December 01. NIH-PA Author Manuscript NIH-PA Author Manuscript NIH-PA Author ManuscriptMethods-Participants were linked to administrative databases to capture hospital admissions during the study period (2005)(2006)(2007)(2008)(2009). Logistic regression was used to identify predictors of medical/surgical and psychiatric hospitalizations.Results-Among 1,165 homeless adults, 20% had a medical/surgical hospitalization and 12% had a psychiatric hospitalization during the study period. These individuals contributed a total of 921 hospitalizations, of which 548 were medical/surgical and 373 were psychiatric. Independent predictors of medical/surgical hospitalization included birth in Canada, having a primary care provider, higher perceived external health locus of control, and lower health status. Independent predictors of psychiatric hospitalization included being a current smoker, having a recent mental health problem, and having a lower perceived internal health locus of control. Being accompanied by a partner or dependent children was protective for hospitalization.Conclusions-Health care need was a strong predictor of medical/surgical and psychiatric hospitalizations. Some hospitalizations among homeless adults are potentially avoidable, while others represent an unavoidable use of health services. KeywordsHospitalization; Homeless persons; Health care utilization Homeless adults are frequent users of inpatient hospital services. In a nationally representative sample of homeless persons in the United States, almost one in four respondents reported being hospitalized in the past year, a rate four times higher than U.S. norms. 1 The frequent use of inpatient hospital services partially reflects the high prevalence of acute and chronic disease, injuries and assaults, and substance use and mental illness among this population. [1][2][3] However, the high rates of hospitalization have also been attributed to a lack of access to primary and preventative care, particularly in the United States where 50% of homeless people have no health insurance. 1,[4][5][6][7] In a nationally representative sample of persons who used homeless services in the United States, Kushel et al. show that lack of health insurance and African American race/ethnicity, as compared to non-Latino white race/ethnicity, were the only factors significantly associated with a lower odds of self-reported hospitalization 1 In a subsequent study, Kushel et al. show that being uninsured significantly decreased the likelihood of self-reporting a non-maternal hospitalization in the past year, while food instability and housing instabilit...

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Section: Discussionmentioning

confidence: 53%

Section: Discussionmentioning

confidence: 99%

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confidence: 99%

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Predictors of Medical or Surgical and Psychiatric Hospitalizations Among a Population-Based Cohort of Homeless Adults

et al. 2013

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“…Homelessness is associated with significant health care needs and health complications, [1][2][3][4] often characterized by very high rates of emergency department use and inpatient hospitalizations [5][6][7] with an underutilizing of ambulatory care services. 8 Often the care provided can best be described as reactive to acute presentations: treating complications of homelessness such as frostbite or exposure-related illnesses; addressing acute complications of chronic conditions that are difficult to manage while homeless; and dealing with the consequences of untreated and undertreated mental health and substance abuse that often precipitate homelessness.…”

Section: Introductionmentioning

confidence: 99%

Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial

et al. 2015

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BACKGROUND: Homeless individuals often have significant unmet health care needs that are critical to helping them leave homelessness. However, engaging them in primary and mental health care services is often elusive and difficult to achieve. OBJECTIVE: We aimed to increase health-seeking behavior and receipt of health care among homeless Veterans. DESIGN: This was a multi-center, prospective, community-based, two-by-two randomized controlled trial of homeless Veterans. PARTICIPANTS: Homeless Veterans not receiving primary care participated in the study. INTERVENTIONS: An outreach intervention that included a personal health assessment and brief intervention (PHA/BI), and/or a clinic orientation (CO) was implemented. MAIN MEASURE: We measured receipt of primary care within 4 weeks of study enrollment. KEY RESULTS: Overall, 185 homeless Veterans were enrolled: the average age was 48.6 years (SD 10.8), 94.6 % were male, 43.0 % were from a minority population, 12.0 % were unsheltered, 25.5 % were staying in a dusk-to-dawn emergency shelter, 26.1 % were in transitional housing, while 27.7 % were in an unstable, doubled-up arrangement. At one month, 77.3 % of the PHA/BI plus CO group accessed primary care and by 6 months, 88.7 % had been seen in primary care. This was followed by the CO-only group, 50.0 % of whom accessed care in the first 4 weeks, the PHI/BI-only arm at 41.0 % and the Usual Care arm at 30.6 %. Chi-squared tests by group were significant (p<0.001) at both 4 weeks and 6 months. There was no difference in attitudes about care at baseline and 6 months or in use patterns once enrolled in care. CONCLUSIONS: Our findings suggest that treatmentresistant/avoidant homeless Veterans can be effectively engaged in primary and other clinical care services through a relatively low intensity, targeted and tailored outreach effort.

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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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Hospitalization Costs Associated with Homelessness in New York City

Abstract: Homelessness is associated with substantial excess costs per hospital stay in New York City. Decisions to fund housing and supportive services for the homeless should take into account the potential of these services to reduce the high costs of hospitalization in this population.

Cited by 275 publications

References 8 publications

Predictors of Medical or Surgical and Psychiatric Hospitalizations Among a Population-Based Cohort of Homeless Adults

Predictors of Medical or Surgical and Psychiatric Hospitalizations Among a Population-Based Cohort of Homeless Adults

Tailoring Outreach Efforts to Increase Primary Care Use Among Homeless Veterans: Results of a Randomized Controlled Trial

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

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