Hospitalization in an urban homeless population: the Honolulu Urban Homeless Project
University of Hawaii, John A. Burns School of Medicine, Honolulu 96822. Annals of internal medicine
(Impact Factor: 17.81).
To determine the rate and estimate the cost of hospitalization in a defined urban homeless population.
Retrospective chart review.
Kalihi-Palama Health Clinic Health Care for the Homeless Project, Hawaii State Hospital and seven acute care hospitals in Honolulu, Hawaii.
A total of 1751 homeless clients contacted between 1 December 1988 and 30 November 1990.
A total of 1751 individuals were studied for an aggregate of 871.3 person-years. Five hundred sixty-four hospitalizations were identified: ninety-two to the state psychiatric hospital and 472 to acute care hospitals. The age- and sex-adjusted hospitalization rate for acute care hospitals was 542/1000 person-years (compared with the state rate of 96/1000 person-years). Homeless persons were admitted to acute care hospitals for 4766 days compared with a predicted 640 days. The age- and sex-adjusted rate of admission to the state psychiatric hospital was 105/1000 person-years (compared with the state rate of 0.8/1000 person-years). Homeless persons were admitted to the state psychiatric hospital for 3837 days compared with a predicted 139 days.
Homeless individuals in this study were hospitalized in acute care and psychiatric hospitals far more frequently than were members of the general population.
Available from: Alicia Fernandez
- "Chronically ill homeless patients account for disproportionate use of hospital resources.– Case management programs for these patients improve health outcomes and reduce readmissions. "
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ABSTRACT: Case management programs for chronically ill, homeless people improve health and resource utilization by linking patients with case managers focused on improving management of medical and psychosocial problems. Little is known about participants' perspectives on case management interventions.
This qualitative study used in-depth, one-on-one interviews to understand the impact of a case management program from the perspective of participants. A standardized interview guide with open-ended questions explored experiences with the case management program and feelings about readiness to leave the program.
FOUR RECURRENT THEMES EMERGED: (1) Participants described profound social isolation prior to case management program enrollment; (2) Participants perceived that caring personal relationships with case managers were key to the program; (3) Participants valued assistance with navigating medical and social systems; and (4) Participants perceived that their health improved through both the interpersonal and the practical aspects of case management.
Chronically ill, homeless people enrolled in a case management program perceived that social support from case managers resulted in improved health. Programs for this population should consider explicitly including comprehensive social support interventions. Further research on case management should explore the impact of different types of social support on outcomes for homeless chronically ill patients.
Available from: Stephen Wesley Hwang
- "Homeless TB patients often have difficulty accessing the health care system and may prioritize subsistence needs such as food and shelter over health services, especially those perceived as discretionary (27). These factors, as well as cultural and language barriers among foreign-born patients (28,29), may contribute to delays in seeking health care, which lead to advanced disease and hospitalization (27,30,31). For our sample, hospitalization rates were high; >80% of patients were hospitalized. "
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ABSTRACT: While tuberculosis (TB) in Canadian cities is increasingly affecting foreign-born persons, homeless persons remain at high risk. To assess trends in TB, we studied all homeless persons in Toronto who had a diagnosis of active TB during 1998-2007. We compared Canada-born and foreign-born homeless persons and assessed changes over time. We identified 91 homeless persons with active TB; they typically had highly contagious, advanced disease, and 19% died within 12 months of diagnosis. The proportion of homeless persons who were foreign-born increased from 24% in 1998-2002 to 39% in 2003-2007. Among foreign-born homeless persons with TB, 56% of infections were caused by strains not known to circulate among homeless persons in Toronto. Only 2% of infections were resistant to first-line TB medications. The rise in foreign-born homeless persons with TB strains likely acquired overseas suggests that the risk for drug-resistant strains entering the homeless shelter system may be escalating.
Available from: James J O'Connell
- "Because housing status is not regularly documented in medical records, we identified individuals as homeless if they had at least one outpatient encounter at the Boston Health Care for the Homeless Program (BHCHP) within ±365 days of the index admission to Boston Medical Center (BMC), an approach used by others (Martell et al., 1992). BHCHP serves over 7,000 homeless individuals annually, identified from over 60 outreach sites. "
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ABSTRACT: Medical respite programs offer medical, nursing, and other care as well as accommodation for homeless persons discharged from acute hospital stays. They represent a community-based adaptation of urban health systems to the specific needs of homeless persons. This article examines whether post-hospital discharge to a homeless medical respite program was associated with a reduced chance of 90-day readmission compared to other disposition options. Adjusting for imbalances in patient characteristics using propensity scores, respite patients were the only group that was significantly less likely to be readmitted within 90 days compared to those released to Own Care. Respite programs merit attention as a potentially efficacious service for homeless persons leaving the hospital.
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