Patient and Primary Care Characteristics Associated with Emergency Department Utilization Among Homeless-Experienced...

Area of Science:

• Health Services Research
• Veterans Health
• Homelessness Studies

Background:

• High emergency department (ED) utilization is a concern for individuals experiencing homelessness.
• Understanding predictors of ED use, including primary care experiences, is crucial for targeted interventions.
• Homeless-tailored primary care clinics often receive better patient ratings, but their impact on ED utilization is unclear.

Purpose of the Study:

• Identify clinical and social predictors of high ED utilization among homeless-experienced veterans (HEVs).
• Determine if unfavorable primary care ratings predict higher ED use.
• Assess if care in homeless-tailored clinics predicts lower ED use compared to mainstream clinics.

Main Methods:

• Retrospective cohort study linking national survey data with electronic health records.
• Assessed ED utilization in the year following survey completion for 5,079 HEVs.
• Analyzed primary care type, patient-reported experience, and high ED utilization (≥4 visits).

Main Results:

• High ED utilization (9.3%) was associated with homelessness, chronic pain, comorbidities, and substance use disorders.
• An unfavorable primary care experience independently predicted higher odds of subsequent high ED utilization (OR 1.31).
• Primary care clinic type was not independently associated with high ED utilization, though homeless-tailored clinics showed a trend towards fewer visits.

Conclusions:

• Clinical complexity and housing instability are primary drivers of high ED utilization among HEVs.
• Improving primary care patient experiences is a potential strategy to reduce ED use in this population.
• Further research into optimizing primary care delivery for HEVs is warranted.