Dedicated homeless clinics reduce inappropriate emergency department utilization

Area of Science:

• Health Services Research
• Public Health
• Healthcare Management

Background:

• Homeless populations exhibit high rates of inappropriate emergency department (ED) utilization.
• A dedicated homeless clinic was established with unique features to address this issue.
• Understanding the impact of specialized care on ED use is crucial for healthcare policy.

Purpose of the Study:

• To evaluate the effectiveness of a dedicated homeless clinic in reducing inappropriate ED utilization.
• To compare ED use patterns between homeless patients attending different types of clinics and those with no clinic visits.

Main Methods:

• Retrospective observational study (July 1, 2017 - Dec 31, 2017).
• Inclusion of all homeless patients with at least one clinic or ED visit.
• Categorization into four groups based on clinic attendance (none, regular clinic, dedicated homeless clinic, both).
• Assessment of ED utilization appropriateness using the New York University algorithm.
• Multivariate logistic regression analysis to identify predictors of inappropriate ED use.

Main Results:

• Patients attending the dedicated homeless clinic showed significantly lower inappropriate ED utilization (21%) compared to those attending regular clinics (29%).
• The dedicated homeless clinic group had a 39% lower likelihood of inappropriate ED visits (adjusted OR = 0.61).
• A total of 5022 unique homeless patients were included, with 16,323 clinic and 8511 ED visits recorded.

Conclusions:

• A dedicated homeless clinic effectively reduces inappropriate emergency department utilization among patients experiencing homelessness.
• This specialized care model demonstrates a successful strategy for optimizing healthcare resource allocation for vulnerable populations.