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Comparing homeless and domiciled patients' utilization of the Harris County, Texas public hospital system
David S Buck1, Carlie A Brown, Karoline Mortensen
1Department of Family and Community Medicine, Baylor College of Medicine, 3701 Kirby Drive, Ste. 600, Houston, TX 77098, USA.
Insights
Homeless individuals face higher mortality and increased healthcare needs. This study reveals their higher readmission rates and longer hospital stays, highlighting the need for better community health services.
Area of Science:
- Public Health
- Health Services Research
- Health Economics
Background:
- Homeless populations experience significantly higher mortality rates (3-6x) compared to housed individuals.
- Elevated rates of mental illness, substance abuse, and co-morbidities increase healthcare demands among the homeless.
- Public hospital systems are a critical, yet often over-utilized, resource for this vulnerable group.
Purpose of the Study:
- To analyze the utilization patterns of Harris County's public hospital system by homeless versus domiciled patients.
- To identify specific healthcare needs and service gaps for homeless individuals within the public hospital setting.
- To evaluate the impact of homelessness on hospital readmission rates and length of stay.
Main Methods:
- Retrospective analysis of data from Harris County, Texas' public hospital system.
- Inclusion of 331 homeless individuals and a random sample of 17,824 domiciled patients.
- Data collection period from June 2008 to July 2009.
Main Results:
- Homeless individuals exhibited increased hospital readmission rates, particularly within 30 days of discharge.
- Significantly higher total annual length of stay was observed for homeless patients.
- Public hospitals were disproportionately utilized for mental illness and HIV care by homeless patients.
Conclusions:
- Lack of integrated community health services drives preventable over-utilization of public hospitals by the homeless.
- Implementing case management, health homes, and medical respite programs can improve outcomes.
- Training healthcare professionals in indigent care is crucial for enhancing the health of homeless populations and reducing system costs.
Abstract:
Homeless individuals have mortality rates three to six times higher than their housed counterparts and have elevated rates of mental illness, substance abuse, and co-morbidities that increase their need for health services. Data on the utilization of Harris County, Texas' public hospital system by 331 homeless individuals and a random sample of 17,824 domiciled patients were obtained from June 2008 to July 2009. Homeless individuals had increased readmission rates, especially within 30 days of discharge, resulting in significantly higher total annual length of stay. Homeless patients also more frequently utilize public hospitals for mental illness and HIV. Lack of community health services contributes to an increased dependence and preventable over-utilization of public hospital systems. Case management interventions integrating primary and behavioral care into health homes, medical respite programs, and training for health care professionals who provide indigent care will improve health outcomes of this population and reduce costs.
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