David Thomas Moore1, Robert A Rosenheck1. 1. The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: david.moore@yale.edu ). Dr. Rosenheck is also with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut.
Abstract
OBJECTIVE: Homeless adults make extensive use of emergency department (ED) services. This study examined factors associated with moderate and high ED use in a cohort of chronically homeless individuals. METHODS: A cross-sectional analysis identified factors related to ED use in a cohort of 755 individuals at 11 sites at entry into the Collaborative Initiative to Help End Chronic Homelessness (CICH). Bivariate analyses identified sociodemographic, housing status, health status, and service-related factors associated with moderate and high ED use. Independent risk factors were then identified by using a multivariate multinomial model. Hierarchical regression was used to compare the strengths of association between ED use and blocks of factors composed of sociodemographic, housing, health, and service-related characteristics. RESULTS: In a three-month period, 30% of participants visited the ED one or two times (moderate ED use) and 12% visited three or more times (high-ED use). ED use was most strongly associated with poor health and utilization of other non-ED services and to a lesser extent with housing status. CONCLUSIONS: Increased ED utilization was associated with both general medical and psychiatric morbidity and greater use of non-ED services. Thus ED use was related to high need and acuity and was not ameliorated by use of other services. Housing instability and homelessness contributed less robustly to increased ED use. More coordinated services may better address the complex medical, housing, and psychosocial needs of chronically homeless individuals.
OBJECTIVE: Homeless adults make extensive use of emergency department (ED) services. This study examined factors associated with moderate and high ED use in a cohort of chronically homeless individuals. METHODS: A cross-sectional analysis identified factors related to ED use in a cohort of 755 individuals at 11 sites at entry into the Collaborative Initiative to Help End Chronic Homelessness (CICH). Bivariate analyses identified sociodemographic, housing status, health status, and service-related factors associated with moderate and high ED use. Independent risk factors were then identified by using a multivariate multinomial model. Hierarchical regression was used to compare the strengths of association between ED use and blocks of factors composed of sociodemographic, housing, health, and service-related characteristics. RESULTS: In a three-month period, 30% of participants visited the ED one or two times (moderate ED use) and 12% visited three or more times (high-ED use). ED use was most strongly associated with poor health and utilization of other non-ED services and to a lesser extent with housing status. CONCLUSIONS: Increased ED utilization was associated with both general medical and psychiatric morbidity and greater use of non-ED services. Thus ED use was related to high need and acuity and was not ameliorated by use of other services. Housing instability and homelessness contributed less robustly to increased ED use. More coordinated services may better address the complex medical, housing, and psychosocial needs of chronically homeless individuals.
Authors: Catharine Chambers; Shirley Chiu; Marko Katic; Alex Kiss; Donald A Redelmeier; Wendy Levinson; Stephen W Hwang Journal: Am J Public Health Date: 2013-10-22 Impact factor: 9.308
Authors: Katherine A Koh; Melanie Racine; Jessie M Gaeta; John Goldie; Daniel P Martin; Barry Bock; Mary Takach; James J O'Connell; Zirui Song Journal: Health Aff (Millwood) Date: 2020-02 Impact factor: 6.301
Authors: William P Horan; Jonathan K Wynn; Sonya Gabrielian; Shirley M Glynn; Gerhard S Hellemann; Robert S Kern; Junghee Lee; Stephen R Marder; Catherine A Sugar; Michael F Green Journal: Am J Orthopsychiatry Date: 2019-04-25
Authors: Rie Sakai-Bizmark; Hiraku Kumamaru; Dennys Estevez; Sophia Neman; Lauren E M Bedel; Laurie A Mena; Emily H Marr; Michael G Ross Journal: BMJ Qual Saf Date: 2021-06-16 Impact factor: 7.418
Authors: Elise D Riley; Eric Vittinghoff; Rose M C Kagawa; Maria C Raven; Kellene V Eagen; Alison Cohee; Samantha E Dilworth; Martha Shumway Journal: J Urban Health Date: 2020-02 Impact factor: 3.671
Authors: Allyson L Varley; Ann Elizabeth Montgomery; Jocelyn Steward; Erin Stringfellow; Erika L Austin; Adam J Gordon; David Pollio; Aerin deRussy; April Hoge; Lillian Gelberg; Kevin Riggs; Theresa W Kim; Sonia L Rubens; Stefan G Kertesz Journal: Qual Health Res Date: 2020-01-02
Authors: Chisom N Iwundu; Pooja Agrawal; Michael S Businelle; Darla E Kendzor; Lorraine R Reitzel Journal: Int J Environ Res Public Health Date: 2020-06-15 Impact factor: 4.614