UCSF

Purpose. To determine the extent to which homeless persons in the United States use the emergency department (ED), the extent to which they use it for non-urgent care and the factors that are predictive of ED use for non-urgent care. Background. The homeless population has a higher morbidity and mortality than the U.S. population in general. Use of the ED for non-urgent care results in poor health outcomes and in ED overcrowding. Delay in emergency care due to overcrowding results in increased morbidity and mortality and contributes to the increasing cost of health care. Methods. Secondary analysis of the National Hospital Ambulatory Medical Care Survey 2005 examines variables from the perspective of predisposing, enabling and need factors that predict non-urgent use of the ED. Results. Chi-square confirmed that homeless people have a significantly higher likelihood of visiting the ED than not homeless (p = 0.007). However, in reference to the extent to which they use the ED for non-urgent visits, Pearson's chi-square test did not indicate a rejection of the null hypothesis (p = 0.763). This finding does not provide support for the hypothesis that urgency of the ED visit is dependent on the housing status of the patient. Multiple logistic regression revealed gender (p = 0.120), race/ethnicity (p = 0.003), season (p = 0.030), health insurance (p< 0.000), physician diagnosis (p< 0.000) and age (p< 0.000) as predictors of ED use for non-urgent care. Discussion. This is the first known study to examine use of the ED by homeless persons in the United States at the national level using empirically derived ED data. Two very important findings emerged from this study: 1) homeless people use the ED in significantly greater proportion than not homeless people, however, they do not use it for non-urgent care in greater magnitude and 2) lack of health insurance significantly increases the likelihood of making a non-urgent visit to the ED.