Sick and unsheltered: Homelessness as a major risk factor for emergency care utilization.

Autor: Amato S; University of Vermont Medical Center, Department of General Surgery, 111 Colchester Avenue, Burlington, VT 05401, United States; University of Rochester School of Medicine and Dentistry, 601 Elmwood Avenue, Rochester, NY 14642, United States., Nobay F; University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Avenue, Rochester, NY 14642, United States., Amato DP, Abar B; University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Avenue, Rochester, NY 14642, United States., Adler D; University of Rochester Medical Center, Department of Emergency Medicine, 601 Elmwood Avenue, Rochester, NY 14642, United States. Electronic address: David_adler@urmc.rochester.edu.
Jazyk: angličtina
Zdroj: The American journal of emergency medicine [Am J Emerg Med] 2019 Mar; Vol. 37 (3), pp. 415-420. Date of Electronic Publication: 2018 Jun 02.
DOI: 10.1016/j.ajem.2018.06.001
Abstrakt: 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.
(Copyright © 2018 Elsevier Inc. All rights reserved.)
Databáze: MEDLINE
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