Factors affecting emergency department use by a chronically homeless population

Abstract

Objective: Homeless adults make extensive use of emergenc department (ED) services. This study examined factor associated with moderate and high ED use in a cohort o chronically homeless individuals Methods: A cross-sectional analysis identified factors relate to ED use in a cohort of 755 individuals at 11 sites a entry into the Collaborative Initiative to Help End Chroni Homelessness (CICH). Bivariate analyses identified sociodemographic housing status, health status, and servicerelate factors associated with moderate and high ED use Independent risk factors were then identified by using multivariate multinomial model. Hierarchical regression wa used to compare the strengths of association between E use and blocks of factors composed of sociodemographic housing, health, and service-related characteristics Results: In a three-month period, 30% of participants visite the ED one or two times (moderate ED use) and 12% visite three or more times (high-ED use). ED use was most strongl associated with poor health and utilization of other non-E services and to a lesser extent with housing status Conclusions: Increased ED utilization was associated wit both general medical and psychiatric morbidity and greate use of non-ED services. Thus ED use was related to hig need and acuity and was not ameliorated by use of othe services. Housing instability and homelessness contribute less robustly to increased ED use. More coordinated service may better address the complex medical, housing, an psychosocial needs of chronically homeless individuals.