More on Population Health

Rates of hospitalization rising among homeless, study finds

Mental illness and substance use disorder are still the main driver of acute hospitalizations among homeless adults.

Jeff Lagasse, Associate Editor

Hospitalization rates among homeless adults have increased sharply in recent years, with a very different set of causes than those in non-homeless individuals, according to a study in the upcoming January issue of Medical Care.

The findings have negative implications for resource use and utilization, and underscores the fact that mental illness and substance use disorder are still the main driver of acute hospitalizations among homeless adults.


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The researchers assessed trends in hospital admissions for homeless adults from 2007 to 2013 in Massachusetts, Florida and California. The analysis included data on more than 185,000 hospitalizations for homeless individuals and 32 million admissions for non-homeless people.

All three states showed a significant increase in hospitalizations for homeless adults: from 294 to 420 per 1,000 homeless residents in Massachusetts; from 161 to 240 per 1,000 in Florida; and from 133 to 164 per 1,000 in California. Most homeless patients were uninsured (42 percent) or insured by Medicaid (32 percent).

Fifty-two percent of homeless patients were hospitalized for mental illness or substance use disorder, compared to 18 percent for non-homeless individuals. Other reasons for hospitalization were less likely in homeless individuals, including cardiovascular disease, gastrointestinal illness, and injury or poisoning.

Homeless patients spent more days in the hospital -- possibly because discharge decisions were affected by their lack of stable housing. They also had lower average costs of care, which may reflect differences in the intensity of care. In-hospital mortality was lower among homeless adults: 0.9 versus 1.2 percent.


"There is really is an urgent need to reduce financial and nonfinancial barriers to the use of ambulatory care, for behavioral health services in particular, to improve long-term management of physical and mental illness for homeless individuals," said senior author Dr. Karen Joynt Maddox, of Washington University in St. Louis.


As value, quality and population health continue to drive the evolution of the healthcare landscape, healthcare systems are wading into social issues more deeply than ever before because they affect the populations these hospitals serve.

Kaiser Permanente, for instance, has committed $200 million to address homelessness in the communities it serves.

Twitter: @JELagasse

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