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Precariously housed patients in a hospital-based medical clinic utilize more emergency room and psychiatric services than stably housed patients

Karran A. Phillips, MD, MS, Internal Medicine/Primary Care Residency Program, Yale New Haven Hospital, LMP 87, New Haven, CT 06511, 203-370-3793, karranp@aol.com, Peter J Ellis, MD, MPH, Primary Care Internal Medicine, Yale University and Waterbury Hospital, 64 Robbins Street, Waterbury, CT 06721, and Rene I. Jahiel, MDPhD, President, International Health Policy Research, 250 Main Street(#732), Hartford, CT 06106.

We sought to screen for precariously housed persons and compare hospital utilization rates and charges among precariously and satisfactorily housed individuals. Housing status information was obtained via questionnaire administered to hospital-based medical clinic patients. Patients were classified as precariously housed if they spent more than 50% of their income on rent/utilities, doubled up, lived in overcrowded/hazardous housing, were recently incarcerated, or received an eviction. Securely housed individuals stated that their house was acceptable and safe. Hospital utilization data was obtained by analyzing hospital financial records. Three hundred and ninety five individuals completed the questionnaire (58% response). Complete hospital utilization and expenditure data was obtained on 346 individuals (88%). Of these 22 (6%) were homeless, 167 (48%) were precariously housed, and 157 (45%) were securely housed. Given the comparatively small number of homeless individuals further analysis was not included. Compared to stably housed precariously housed individuals had on average more emergency room visits (5.3 vs. 4.3, p<0.05), more inpatient visits (1.3 vs. 1.0), longer hospital stays (7.6 vs. 4.3 days, p<0.05), more psychiatric inpatient visits (4.7 vs. 2.7, p<0.05), and more psychiatric outpatient visits (6.3 vs. 4.5, p<0.05). Additionally, average hospital charges were greater for precariously housed individuals ($15,339 vs. $10, 544, p<0.05). Our data demonstrates that it is feasible to identify precariously housed individuals and that they are more likely to utilize emergency room and psychiatric services than stably housed individuals. Interventions targeting precariously housed individuals may provide a valuable opportunity to prevent serious health problems associated with homelessness.

Learning Objectives:

Presenting author's disclosure statement:
I do not have any significant financial interest/arrangement or affiliation with any organization/institution whose products or services are being discussed in this session.

Access to and Utilization of Health and Human Services Among the Homeless

The 132nd Annual Meeting (November 6-10, 2004) of APHA