Antemortem Health System Utilization in People Experiencing Homelessness Who Died in the Emergency Department

Area of Science:

• Public Health
• Emergency Medicine
• Health Services Research

Background:

• People experiencing homelessness (PEH) exhibit elevated mortality rates, complex medical and psychiatric conditions, and frequent emergency department (ED) use.
• Understanding the characteristics and healthcare utilization of PEH who die within the ED is crucial for targeted interventions.

Purpose of the Study:

• To identify and characterize People Experiencing Homelessness (PEH) pronounced dead in the emergency department.
• To analyze prehospital and in-hospital factors, as well as prior healthcare utilization patterns, for PEH who died in the ED.

Main Methods:

• Retrospective evaluation of emergency department encounters for People Experiencing Homelessness (PEH) who were pronounced dead.
• Collection of patient demographics, medical history, prehospital data, ED characteristics, and healthcare utilization patterns.
• Descriptive statistical analysis of the collected data.

Main Results:

• 48 PEH were identified as deceased in the ED, with a mean age of 46.5 years.
• The majority (92%) presented in cardiac arrest, with 25% of these cases linked to substance use; 8% presented with trauma.
• In the year preceding death, 32% of decedents had no documented healthcare utilization, while 33% had 10 or more ED/outpatient visits.

Conclusions:

• This study is the first to characterize PEH who died in the ED, detailing their prehospital, in-hospital, and prior health system use.
• A significant portion of deceased PEH had no healthcare contact in the 12 months prior to death, suggesting underutilization of services by high-risk individuals.
• Conversely, a similar proportion with extensive prior healthcare use indicates potential missed opportunities for mortality reduction.