142nd APHA Annual Meeting and Exposition

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Perceived health and emergency department utilization among chronically homeless adults in permanent supportive housing

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Monday, November 17, 2014

Lori Thomas, PhD, MSW , Department of Social Work, University of North Carolina at Charlotte, Charlotte, NC
Tom Ludden, PhD , Carolinas Healthcare System, Charlotte, NC
Jeffrey Shears, PhD , Social Work, UNC Greensboro/NC A&T, Greensboro, NC
Mary Ann Priester, MSW , College of Social Work, University of South Carolina, Columbia, SC
Background: Poor perceived health and mental health are risk factors for increased utilization of emergency medical departments (EDs). Chronically homeless individuals are frequent users of emergency health services, often using EDs to address non-emergency health needs. Permanent Supportive Housing  (PSH) can reduce the ED utilization of chronically homeless adults, but no study has examined the relationship between ED utilization and self-perceptions of health and mental health in this population.

Methods: This study used self-report and local hospital billing data to examine the relationship between ED utilization and the perceived health and mental health of chronically homeless individuals (N=61) living in a PSH program in Charlotte, North Carolina.  Local hospital billing data was collected for the year prior and the year following each consenting tenant’s move into the PSH program. Self-report data was collected within one month of program entry and after one year of tenancy.

Results: In the year after moving into PSH, the average number of tenant ED visits decreased from 9.3 (SD=20.3) to 2.0 (SD=4.4) visits; t(60)=3.435, p=.001.  The average length of hospitalizations originating from those visits decreased from 7.6 (SD=16.4) to 1.6 (SD=4.7) days; t(60)=2.850, p=006. Scores for self-perceptions of health and mental health, however, did not change over the first year of tenancy, and for the majority of tenants remained low, below general population norms.

Discussion: Study findings underscore the effectiveness of PSH in interrupting frequent utilization of EDs despite tenant perceptions of poor health. Implications for ongoing health programming in PSH are addressed.

Learning Areas:

Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
Describe the relationship between chronic homelessness and healthcare utilization; Examine the role permanent supportive housing plays in reducing the healthcare utilization of chronically homeless adults; Discuss the program implications of poor perceptions of health that persist despite reduced utilization of healthcare services.

Keyword(s): Homelessness, Utilization

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have been the principal investigator for two externally-funded studies on chronic homelessness and homelessness among older homeless adults. In addition, I have over 10 years of practice experience in homelessness and housing, including developing a permanent supportive housing program for chronically homeless adults with a serious and persistent mental illness.
Any relevant financial relationships? No

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.

Back to: 3315.0: Public Health Social Work Section Poster Session