The Urban Homeless: Super-users of the Emergency Department
| Autor: | Abbie Santana, Kevin Scott, Daniel Wasserman, Laura Borman, Bon S. Ku, J. Matthew Fields |
|---|---|
| Rok vydání: | 2014 |
| Předmět: |
Adult
Male Urban Population Leadership and Management Cross-sectional study Population Psychological intervention Medical Records Health care medicine Humans education Retrospective Studies Philadelphia Academic Medical Centers education.field_of_study Insurance Health business.industry Health Policy Medical record Public Health Environmental and Occupational Health Emergency department Middle Aged medicine.disease Hospital Charges Emergency Severity Index Cross-Sectional Studies Ill-Housed Persons Female Medical emergency Emergency Service Hospital business Medicaid |
| Zdroj: | Population Health Management. 17:366-371 |
| ISSN: | 1942-7905 1942-7891 |
| DOI: | 10.1089/pop.2013.0118 |
| Popis: | In the United States, patient usage of costly emergency departments (EDs) has been portrayed as a major factor contributing to health care expenditures. The homeless are associated with ED frequent users, a population often blamed for inappropriate ED use. This study examined the characteristics and costs associated with homeless ED frequent users. A retrospective cross-sectional review of hospital records for ED visits in 2006 at an urban academic medical center was performed. Frequent users were defined as having greater than 4 ED visits in one year. Homeless status was determined by self-report and review by an interdisciplinary team. A total of 5440 (8.9%) ED visits were made by 542 frequent users, 74 (13.7%) of whom were homeless and made 845 ED visits. Homeless frequent users had a median age of 47 years (39-56 interquartile range), were predominantly male (85.1%), and insured by Medicaid (59.5%). Most (44.2%) visits by homeless frequent users occurred between 1500-2259 hours and had an Emergency Severity Index of Level 3 (55.5%). Sixty-four percent of visits resulted in homeless patients being discharged back to the street; only 4.0% had a specific discharge plan addressing homelessness. Total charges and payments for all homeless frequent users were $4,812,615 and $802,600, respectively. The single top frequent user accrued charges of $482,928. ED frequent users are disproportionately homeless and their costs are significant. ED discharge planning should address the additional risks faced by homeless individuals. ED-based interventions that specifically target the most expensive homeless frequent users may prove to be cost-effective. |
| Databáze: | OpenAIRE |
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