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Desai, Mayur M.; Rosenheck, Robert A.; Kasprow, Wesley J.

doi:10.1097/00005650-200302000-00009

Cited by 13 publications

(17 citation statements)

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“…Homeless adults have increased rates of social isolation, unstable housing, hunger, safety concerns, and legal problems—all of which have been identified as associated with ED use (18, 21, 22). Homeless adults are less likely to have health insurance (21) and many have limited access to ambulatory services (6, 11, 23, 24). There is evidence that that lack of both insurance and ready access to ambulatory services are associated with increased ED usage (21, 25–27).…”

Section: Introductionmentioning

confidence: 99%

Factors Affecting Emergency Department Use by a Chronically Homeless Population

Moore¹,

Rosenheck²

2016

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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 in 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 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 3-month period, 30% of participants visited the ED 1 or 2 times (moderate ED use) and 12% used the ED 3 or more times (high-ED use). ED use was most strongly associated with poor health status and utilization of other non-ED services, and to a lesser extent with housing status. Conclusions Increased ED utilization was associated with both medical and psychiatric morbidity and greater use of non-ED services. ED use is thus related to high need and acuity and is not ameliorated by use of other services. Housing instability and homelessness contribute 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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Section: Introductionmentioning

confidence: 99%

Factors Affecting Emergency Department Use by a Chronically Homeless Population

Moore¹,

Rosenheck²

2016

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“…Care management programs for all homeless Veterans are vital to address disparities in VA health service utilization. 3, 4 Last, the slow, iterative nature of our framework promotes QI, but this formative evaluation does not enable us to analyze health outcomes that will be important in future improvement efforts.…”

Section: Discussionmentioning

confidence: 99%

“…1 Unfortunately, homeless Veterans have high rates of chronic illness, 2 limited primary care utilization, 3–5 and an age-adjusted mortality that is nearly three times higher than their housed counterparts. 6 …”

Section: Introductionmentioning

confidence: 99%

Chronic Disease Management for Recently Homeless Veterans

Gabrielian

Yuan²,

Andersen³

et al. 2013

Medical Care

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Background Though vulnerable populations may benefit from in-home health information technologies (HIT) that promote disease self-management, there is a “digital divide” in which these groups are often unlikely to use such programs. We describe the early phases of applying and testing an existing Veterans Administration (VA) HIT care management program, Care Coordination Home Telehealth (CCHT), to recently homeless Veterans in the U.S. Department of Housing and Urban Development-VA Supportive Housing (HUD-VASH) program. Peers were used to support patient participation. Methods CCHT uses in-home messaging devices to provide health education and daily questions about clinical indicators from chronic illness care guidelines, with patient responses reviewed by VA nurses. Patients could also receive adjunctive peer support. We used medical record review, Veteran interviews, and staff surveys to “diagnose” barriers to CCHT use, assess program acceptability, explore the role of peer support, and inform future quality improvement. Subjects Fourteen eligible Veterans in HUD-VASH agreed to CCHT participation. Ten of these Veterans opted to have adjunctive peer support and the other four enrolled in CCHT usual care. Results Though barriers to enrollment/engagement must be addressed, this subset of Veterans in HUD-VASH was satisfied with CCHT. Most Veterans did not require support from peers to engage in CCHT but valued peer social assistance amidst the isolation felt in their scattered-site homes. Conclusions HIT tools hold promise for in-home care management for recently housed Veterans. Patient-level barriers to enrollment must be addressed in the next steps of quality improvement, testing and evaluating peer-driven CCHT recruitment.

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“…1–6 Substandard housing is associated with chronic illnesses and psychiatric problems, 1 and homeless persons have poor health, 3,7,8 limited primary and preventive care, 9,10 and fragmented health care utilization. 7,10–12 …”

mentioning

confidence: 99%

VA Health Service Utilization for Homeless and Low-income Veterans

et al. 2014

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Background The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program—the VA’s Housing First effort—is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. Objectives We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. Research Design We performed a secondary database analysis of Veterans (n = 62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. Results HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. Conclusions Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.

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Cited by 13 publications

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Factors Affecting Emergency Department Use by a Chronically Homeless Population

Factors Affecting Emergency Department Use by a Chronically Homeless Population

Chronic Disease Management for Recently Homeless Veterans

VA Health Service Utilization for Homeless and Low-income Veterans

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