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APHA Scientific Session and Event Listing
5004.0: Wednesday, November 07, 2007 - Board 1

Abstract #147956

Beyond housing and health service use outcomes in research on the homeless: Nursing homes and jails

Laura Sadowski, MD, MPH1, Romina Kee, MD, MPH2, Diana Garcia, MPH2, and David Buchanan, MD3. (1) Collaborative Research Unit/Department of Medicine, John Stroger Hospital/Rush Medical College, 1900 West Polk Street, Room 1603, Chicago, IL 60612, 312-864-3680, sadowski@cchil.org, (2) Collaborative Research Unit/Department of Medicine, Stroger Hospital of Cook County, 1900 West Polk Street, Room 1606, Chicago, IL 60612, (3) Division of General Medicine/Section of Social Medicine, John Stroger Hospital/Rush Medical College, 1900 West Polk Street, Room 1458, Chicago, IL 60612

Introduction: Homeless outcomes research has focused on costly hospitalizations and emergency room visits. There are other costly outcomes of the homeless that are relevant to policy makers, namely nursing home and incarcerations stays.

Methods: We conducted a Randomized Controlled Trial of 407 homeless adults with chronic medical illnesses, following them for 18 months. Enrollment occurred in two Chicago hospitals. Adults who were able to self-care upon hospital discharge were eligible. We interviewed participants six times between their enrolling hospitalization and the 18 month study follow-up period to assess their housing and health service locations after enrollment. In addition, we conducted active surveillance of the local and state jail and prisons, as well as verified reported nursing homes stays.

Results: Our sample was 75% men, 75% African American, 34% HIV seropositive with a median age of 47. Our follow-up rate at the 18 month study end point was 81% interviewed; and higher for surveillance outcomes such as incarceration stays. During the study follow-up period 18% (n=74) stayed in nursing homes for a total of 10,559 days with direct costs of $1,065,153. Similarly 17% (n=69) were incarcerated for a total of 10,178 days. These incarceration days represent direct costs of $814,240.

Conclusions: Nursing home and incarceration stays and their resultant costs were substantial in this cohort. Cost effectiveness studies of the homeless should include nursing home stays and incarceration days in addition to traditional health and housing outcomes.

Learning Objectives:

Keywords: Homeless, Outcomes Research

Presenting author's disclosure statement:

Any relevant financial relationships? No
Any institutionally-contracted trials related to this submission?

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.

Issues Related to the Design, Implementation, and Effectiveness of Health Services for Homeless Populations

The 135th APHA Annual Meeting & Exposition (November 3-7, 2007) of APHA