Featured Research

from universities, journals, and other organizations

Program Reduces Hospital And Emergency Department Use Among Homeless Adults With Chronic Illnesses

Date:
May 5, 2009
Source:
JAMA and Archives Journals
Summary:
An intervention that provided housing and case management to homeless adults with chronic medical illnesses reduced hospitalizations and emergency department visits.

An intervention that provided housing and case management to homeless adults with chronic medical illnesses reduced hospitalizations and emergency department visits.

Addressing the health needs of the homeless population is a challenge to physicians, health institutions, and federal, state, and local governments, with an estimated 3.5 million individuals in the U.S. likely to experience homelessness in a given year. Rates of chronic medical illness are high among homeless adults, who are frequent users of costly emergency department and hospital services, largely paid for by public dollars. "The combination of chronic medical illnesses and poor access to primary health care has substantial health and economic consequences," the authors write.

Laura S. Sadowski, M.D., M.P.H., of Stroger Hospital of Cook County, Chicago, and colleagues conducted a study to determine whether an intervention that provided housing and case management for homeless adults with chronic medical illness would reduce hospitalizations and visits to the emergency department. Participants (n = 405; 78 percent men, 78 percent African American, with a median [midpoint] duration of homelessness of 30 months) were randomized to the intervention or usual care. The intervention (n = 201) included transitional housing after hospitalization discharge, followed by placement in long-term housing. Case managers facilitated the participant's housing placement and coordinated appropriate medical care, with substance abuse and mental health treatment referrals coordinated as needed. Usual care (n = 204) consisted of participants receiving standard discharge planning from hospital social workers.

After 18 months, 73 percent of participants had at least 1 hospitalization or emergency department visit. During this time period there were 583 hospitalizations in the intervention group (1.93 hospitalizations/person per year) and 743 in the usual care group (2.43 hospitalizations/person per year), with a reduction of 0.5 hospitalizations/person per year, and a reduction of 2.7 hospital days/person per year in the intervention group compared with the usual care group. Over 18 months, there were 2.61 emergency department visits/person per year in the intervention group and 3.77 visits/person per year in the usual care group, a reduction of 1.2 emergency department visits/person per year.

After adjusting for various factors, compared with the usual care group, the intervention group had a relative reduction of 29 percent in hospitalizations, 29 percent in hospital days and 24 percent in emergency department visits.

"Several factors could account for the success of our intervention. First, our case management program was linked to the medical system and provided coordinated services across the full spectrum of settings—hospitals, respite care centers, and stable and unstable community housing. Second, our intervention recognized the heterogeneity within the homeless population and tried to tailor the supportive housing to the participant's needs and characteristics. Third, our intervention represented a city-wide consortium of clinicians, social workers, and housing and other advocacy groups, which facilitated a comprehensive and coordinated effort to obtain case management and housing for every intervention participant."

"These results provide a rationale and a blueprint for programs that address the needs of this vulnerable population," the authors conclude.

Editorial: Housing the Chronically Homeless - High Hopes, Complex Realities

In an accompanying editorial, Stefan G. Kertesz, M.D., M.Sc., of the University of Alabama at Birmingham and Saul J. Weiner, M.D., of the University of Illinois at Chicago, write that the findings in this study and a study by Larimer et al, which appeared in the April 1, 2009 issue of JAMA, provide important information on the results of certain programs for the homeless.

"The studies by Larimer et al and Sadowski et al add to the increasing evidence that at least some large U.S. cities cannot afford not to house some who live on their streets. These studies demonstrate that for the most frequent users of costly public services, service use substantially abates when individuals have stable housing. The challenge now is to determine which subgroups of the homeless population could benefit most from Housing First, a valuable new approach—if not a panacea—in the quest to end homelessness."


Story Source:

The above story is based on materials provided by JAMA and Archives Journals. Note: Materials may be edited for content and length.


Journal Reference:

  1. Laura S. Sadowski; Romina A. Kee; Tyler J. VanderWeele; David Buchanan. Effect of a Housing and Case Management Program on Emergency Department Visits and Hospitalizations Among Chronically Ill Homeless Adults. JAMA, 2009;301(17):1771-1778 [link]

Cite This Page:

JAMA and Archives Journals. "Program Reduces Hospital And Emergency Department Use Among Homeless Adults With Chronic Illnesses." ScienceDaily. ScienceDaily, 5 May 2009. <www.sciencedaily.com/releases/2009/05/090505162437.htm>.
JAMA and Archives Journals. (2009, May 5). Program Reduces Hospital And Emergency Department Use Among Homeless Adults With Chronic Illnesses. ScienceDaily. Retrieved September 18, 2014 from www.sciencedaily.com/releases/2009/05/090505162437.htm
JAMA and Archives Journals. "Program Reduces Hospital And Emergency Department Use Among Homeless Adults With Chronic Illnesses." ScienceDaily. www.sciencedaily.com/releases/2009/05/090505162437.htm (accessed September 18, 2014).

Share This



More Health & Medicine News

Thursday, September 18, 2014

Featured Research

from universities, journals, and other organizations


Featured Videos

from AP, Reuters, AFP, and other news services

Artificial Sweetener Could Promote Diabetes

Artificial Sweetener Could Promote Diabetes

Newsy (Sep. 17, 2014) Doctors once thought artificial sweeteners lacked the health risks of sugar, but a new study says they can impact blood sugar levels the same way. Video provided by Newsy
Powered by NewsLook.com
Ebola Vaccine Trial Gets Underway at Oxford University

Ebola Vaccine Trial Gets Underway at Oxford University

AFP (Sep. 17, 2014) A healthy British volunteer is to become the first person to receive a new vaccine for the Ebola virus after US President Barack Obama called for action against the epidemic and warned it was "spiralling out of control." Duration: 01:02 Video provided by AFP
Powered by NewsLook.com
Obesity Rates Steady Even As Americans' Waistlines Expand

Obesity Rates Steady Even As Americans' Waistlines Expand

Newsy (Sep. 17, 2014) Researchers are puzzled as to why obesity rates remain relatively stable as average waistlines continue to expand. Video provided by Newsy
Powered by NewsLook.com
President To Send 3,000 Military Personnel To Fight Ebola

President To Send 3,000 Military Personnel To Fight Ebola

Newsy (Sep. 16, 2014) President Obama is expected to send 3,000 troops to West Africa as part of the effort to contain Ebola's spread. Video provided by Newsy
Powered by NewsLook.com

Search ScienceDaily

Number of stories in archives: 140,361

Find with keyword(s):
Enter a keyword or phrase to search ScienceDaily for related topics and research stories.

Save/Print:
Share:

Breaking News:
from the past week

In Other News

... from NewsDaily.com

Science News

Health News

Environment News

Technology News



Save/Print:
Share:

Free Subscriptions


Get the latest science news with ScienceDaily's free email newsletters, updated daily and weekly. Or view hourly updated newsfeeds in your RSS reader:

Get Social & Mobile


Keep up to date with the latest news from ScienceDaily via social networks and mobile apps:

Have Feedback?


Tell us what you think of ScienceDaily -- we welcome both positive and negative comments. Have any problems using the site? Questions?
Mobile: iPhone Android Web
Follow: Facebook Twitter Google+
Subscribe: RSS Feeds Email Newsletters
Latest Headlines Health & Medicine Mind & Brain Space & Time Matter & Energy Computers & Math Plants & Animals Earth & Climate Fossils & Ruins