title: Health care utilization among homeless adults prior to death.
abstract: This study characterizes health care utilization prior to death in a group of 558 homeless adults in Boston. In the year before death, 27 percent of decedents had no outpatient visits, emergency department visits, or hospitalizations except those during which death occurred. However, 21 percent of homeless decedents had a health care contact within one month of death, and 21 percent had six or more outpatient visits in the year before death. Injection drug users and persons with HIV infection were more likely to have had contact with the health care system. This study concludes that homeless persons may be underusing health care services even when they are at high risk of death. Because a subset of homeless persons had extensive health care contacts prior to death, opportunities to prevent deaths may have been missed, and some deaths may not have been preventable through medical intervention.
authors.affiliation: St. Michael's Hospital, Inner City Health Program, Shuter Wing 2-026, 30 Bond Street, Toronto, Ontario.
authors.forename: S W
authors.initials: SW
authors.lastname: Hwang
authors.forename: J J
authors.initials: JJ
authors.lastname: O'Connell
authors.forename: J M
authors.initials: JM
authors.lastname: Lebow
authors.forename: M F
authors.initials: MF
authors.lastname: Bierer
authors.forename: E J
authors.initials: EJ
authors.lastname: Orav
authors.forename: T A
authors.initials: TA
authors.lastname: Brennan
mesh_terms: D000328:Adult; D000368:Aged; D001900:Boston / Q000453:epidemiology; D002423:Cause of Death; D003625:Data Collection; D005006:Ethnicity / Q000706:statistics & numerical data; D005260:Female; D015658:HIV Infections / Q000453:epidemiology / Q000401:mortality; D006297:Health Services Accessibility; D006703:Ill-Housed Persons / Q000145:classification / Q000706:statistics & numerical data*; D006786:Hospitals, Urban / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009017:Morbidity; D009026:Mortality; D019966:Substance-Related Disorders / Q000453:epidemiology; D019037:Urban Health Services / Q000706:statistics & numerical data*