Abstract
Objective
Homelessness is a critical public health issue and socioeconomic epidemic associated
with a disproportionate burden of disease and significant decrease in life expectancy.
We compared emergency care utilization between individuals with documented homelessness
to those enrolled in Medicaid without documented homelessness.
Methods
We conducted a retrospective cohort study consisting of electronic medical record
review of demographics, chief complaints, and health care utilization metrics of adults
with homelessness compared to a group enrolled in Medicaid without identified homelessness.
The chart review spanned two years of emergency visits at a single urban, academic,
tertiary care medical center. Descriptive statistics, bivariate and multivariate analyses
were utilized.
Results
Over the study period, 986 patients experiencing homelessness accounted for 7532 ED
visits, with a mean of 7.6 (SD 19.9) and max of 316 visits. The control group of 3482
Medicaid patients had 5477 ED visits, with a mean of 1.6 visits (SD 2.1) and max of
49 visits. When controlling for age, sex, race, ethnicity, and ESI, those living with
homelessness were 7.65 times more likely to return to the ED within 30 days of their
previous visit, 9.97 times more likely to return within 6 months, 10.63 times more
likely to return within one year, and 11 times more likely to return within 2 years.
Conclusions
Compared to non-homeless Medicaid patients, patients with documented homelessness
were over seven times more likely to return to the ED within 30 days and over eleven
times more likely to return to the ED in two years.
Keywords
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Article Info
Publication History
Published online: June 02, 2018
Accepted:
June 1,
2018
Received in revised form:
May 31,
2018
Received:
April 13,
2018
Identification
Copyright
© 2018 Elsevier Inc. All rights reserved.
