Health Policy and Health Services Research
Background: Homeless patients tend to use Emergency Department (ED) as their primary medical home resulting in higher ED utilizations. However, it is unknown whether higher utilizations is associated with prolonged homeless conditions. Therefore, we aim to investigate ED utilization patterns among patients with different homeless durations.
Methods: We performed a retrospective single center cohort study from Jan.1, 2014 to Dec. 31, 2017. Patients who were enrolled in this study were identified as having a homeless status on their first ED visit during study period. Statuses were updated every 6 months. We divided patients into two groups. Group 1 had patients who kept their homeless statuses constantly whereas group 2 had patients alternating homeless with non-homeless statuses. The duration of homeless conditions was divided into four groups [homeless duration less than 1 year, 1-2 years, 2-3 years, and 3-4 years]. Our primary outcome is the number of ED utilizations among patients with different homeless durations. Wilcoxon rank sum test was used for median comparisons among groups
Results: We enrolled a total of 6,216 homeless patients with 33,682 ED visits during the study period. Among which, 5,873 patients registered as homeless constantly and 343 patients had alternating conditions, median numbers of ED utilizations in patients under constant homeless statuses were 2 (1,4) ED visits the first year, 2 (1,4) ED visits the second year, 2 (1,3) ED visits the third year, and 2 (1, 3.5) ED visits the fourth year (p>0.05). However, median numbers of ED utilizations in patients with alternating statuses were 4 (2, 7) ED visits the first year, 3(1,6) ED visits the second year, 3 (1,6) ED visits the third year, and 2(1,5) ED visits the fourth year
Conclusions: More ED utilizations occurred among patients with alternating homelessness than ones with a constant status of homelessness. Prolonged homelessness did not increase ED utilizations among patients with constant homeless statuses. ED utilization was decreased with prolonged homelessness regardless of the consistency of homelessness.