253 Are Demographic Variations Among Homeless Patients Associated With Emergency Department Utilization?

Abstract

Homeless patients are often perceived to overuse emergency departments (EDs). However, little is known about the variability within this population regarding ED use. In this study, we analyzed the associations between demographic factors in the homeless population and patterns of ED use. A retrospective study using patient databases from SMD and four of Detroit’s major hospitals, Detroit Receiving (DRH), Harper-Hutzel (HUH), Sinai-Grace (SGH), and Henry Ford (HF) hospitals, was conducted. Medical records from a medical student-run street medicine clinic (Street Medicine Detroit - SMD) were matched to the hospitals’ electronic medical records (EMR) one year before and after the initial 2014-2015 SMD encounter using unique patient identifiers. Proportions and means were compared across groups using chi square and t-test statistics respectively. Of 306 SMD patients identified in 2014-2015, 179 (58.5%) had an ED visit within one year of their initial 2014-2015 SMD encounter. Of the SMD patients who also visited the ED, 134 (74.9%) were male. In that same population, 115 (64.2%) were African-American. Among the SMD patients who did not go to the ED, 101 (79.5%) were male, and 98 patients (77.2%) were african-american. The average age of SMD patients who used the ED was similar to that of those who did not use the ED (49.8 years and 49.4 years, respectively). 115 (64.2%) SMD patients utilizing the ED were African-American. 98 (77.2%) SMD patients who did not use the ED were also African-American. Of the patients who visited the ED within one year of their 2014-2015 SMD encounter, 19 (10.6%) had stable living conditions, 66 (36.9%) had unstable living conditions, and 22 (12.3%) lived outside. Of the patients who did not visit the ED, 12 (9.4%) had stable living conditions, 32 (25.2%) were unstably housed, and 12 (9.4%) lived outside. The “unsure” denotation indicates the patient did not specifically disclose their living arrangements. Based on observations of the SMD population, the subset of the homeless who use EDs are more likely to have unstable housing situations, and are more likely to use street drugs. These findings are consistent with previous studies of high ED utilizers, and suggest that only a comprehensive approach, addressing social, physical, and mental health needs of this population will be effective in reducing unnecessary ED use and health care costs.