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Published Online: 15 July 2016

Factors Affecting Emergency Department Use by a Chronically Homeless Population

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.

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Information & Authors

Information

Published In

Go to Psychiatric Services
Go to Psychiatric Services

Cover: pocket watch, by Robert et Courvoisier, 1800–1816. Silver, brass, ormuolu, enamel, and steel. Bequest of Henry Francis du Pont, Winterthur Museum, Winterthur, Del.

Psychiatric Services
Pages: 1340 - 1347
PubMed: 27417899

History

Received: 8 December 2015
Revision received: 4 April 2016
Accepted: 25 April 2016
Published online: 15 July 2016
Published in print: December 01, 2016

Authors

Details

David Thomas Moore, M.D., Ph.D.
The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: [email protected]). Dr. Rosenheck is also with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut.
Robert A. Rosenheck, M.D.
The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: [email protected]). Dr. Rosenheck is also with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut.

Competing Interests

The authors report no financial relationships with commercial interests.

Funding Information

U.S. Department of Housing and Urban Development10.13039/100000204
U.S. Department of Health and Human Services10.13039/100000016
U.S. Department of Veterans Affairs10.13039/100000738
National Institute of Mental Health10.13039/100000025: 5T32MH062994-13
The Collaborative Initiative to Help End Chronic Homelessness Funder's Group, representing the U.S. Department of Housing and Urban Development, the U.S. Department of Health and Human Services, and the Department of Veterans Affairs, provided support and guidance to this evaluation. This material is also based on work supported by the Office of Research and Development, Veterans Health Administration. Further financial support was provided by training grant 5T32MH062994-13 from the National Institute of Mental Health.

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