title: Admission decisions and outcomes of community-acquired pneumonia in the homeless population: a review of 172 patients in an urban setting.
abstract: OBJECTIVE
  We compared admission rates, outcomes, and performance of the CURB-65 mortality prediction score of homeless patients and nonhomeless patients with community-acquired pneumonia (CAP).
  
  
  METHODS
  We compared homeless (n = 172) and nonhomeless (n = 1897) patients presenting to a Salt Lake City, Utah, emergency department with CAP from 1996 to 2006. In the homeless cohort, we measured referral from and follow-up with the local homeless health care clinic and arrangement of medical housing.
  
  
  RESULTS
  Homeless patients were younger (44 vs 59 years; P < .001) and had lower CURB-65 scores and higher hospitalization risk (severity-adjusted odds ratio = 1.89; 95% confidence interval = 1.33, 2.69) than did nonhomeless patients, with a similar length of stay, median inpatient cost, and median outpatient cost, even after severity adjustment. Of homeless patients, 22% were referred from the homeless health care clinic to the emergency department; 54% of outpatients and 51% of hospital patients were referred back to the clinic, and medical housing was arranged for 23%.
  
  
  CONCLUSIONS
  A large cohort of homeless patients with CAP demonstrated higher hospitalization risk than but similar length of stay and costs as nonhomeless patients. The strong relationship between the hospital and homeless health care clinic may have contributed to this finding.
authors.affiliation: Barbara Jones, Samuel M. Brown, and Nathan C. Dean are with the Divisions of Pulmonary and Critical Care Medicine, University of Utah, Salt Lake City. Adi V. Gundlapalli is with the Division of Epidemiology, University of Utah, and the Department of Veterans Affairs, Salt Lake City. Samuel M. Brown and Nathan C. Dean are also with Intermountain Medical Center, Murray, UT. Jason P. Jones is with Kaiser Permanente, Pasadena, CA, and Intermountain Medical Center, Murray.
authors.forename: Barbara
authors.initials: B
authors.lastname: Jones
authors.forename: Adi V
authors.initials: AV
authors.lastname: Gundlapalli
authors.forename: Jason P
authors.initials: JP
authors.lastname: Jones
authors.forename: Samuel M
authors.initials: SM
authors.lastname: Brown
authors.forename: Nathan C
authors.initials: NC
authors.lastname: Dean
mesh_terms: D000328:Adult; D015331:Cohort Studies; D015897:Comorbidity; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D005102:Health Expenditures / Q000706:statistics & numerical data; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D007902:Length of Stay / Q000191:economics / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010343:Patient Admission / Q000191:economics / Q000706:statistics & numerical data*; D011014:Pneumonia / Q000191:economics / Q000453:epidemiology* / Q000401:mortality; D012720:Severity of Illness Index; D014505:Urban Population / Q000706:statistics & numerical data*; D014589:Utah / Q000453:epidemiology