title: The role of charity care and primary care physician assignment on ED use in homeless patients.
abstract: OBJECTIVE
  Homeless patients are a vulnerable population with a higher incidence of using the emergency department (ED) for noncrisis care. Multiple charity programs target their outreach toward improving the health of homeless patients, but few data are available on the effectiveness of reducing ED recidivism. The aim of this study is to determine whether inappropriate ED use for nonemergency care may be reduced by providing charity insurance and assigning homeless patients to a primary care physician (PCP) in an outpatient clinic setting.
  
  
  METHODS
  A retrospective medical records review of homeless patients presenting to the ED and receiving treatment between July 2013 and June 2014 was completed. Appropriate vs inappropriate use of the ED was determined using the New York University ED Algorithm. The association between patients with charity care coverage, PCP assignment status, and appropriate vs inappropriate ED use was analyzed and compared.
  
  
  RESULTS
  Following New York University ED Algorithm standards, 76% of all ED visits were deemed inappropriate with approximately 77% of homeless patients receiving charity care and 74% of patients with no insurance seeking noncrisis health care in the ED (P=.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (P=.019).
  
  
  CONCLUSIONS
  Both charity care homeless patients and those without insurance coverage tend to use the ED for noncrisis care resulting in high rates of inappropriate ED use. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED use in homeless patients.
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX 76104. Electronic address: hwang01@jpshealth.org.
authors.forename: Hao
authors.initials: H
authors.lastname: Wang
authors.affiliation: Department of Family Medicine, University of North Texas Health Science Center, Fort Worth, TX 76107.
authors.forename: Vicki A
authors.initials: VA
authors.lastname: Nejtek
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX 76104.
authors.forename: Dawn
authors.initials: D
authors.lastname: Zieger
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX 76104.
authors.forename: Richard D
authors.initials: RD
authors.lastname: Robinson
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX 76104.
authors.forename: Chet D
authors.initials: CD
authors.lastname: Schrader
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX 76104.
authors.forename: Chase
authors.initials: C
authors.lastname: Phariss
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX 76104.
authors.forename: Jocelyn
authors.initials: J
authors.lastname: Ku
authors.affiliation: Department of Emergency Medicine, Integrative Emergency Services, John Peter Smith Health Network, Fort Worth, TX 76104.
authors.forename: Nestor R
authors.initials: NR
authors.lastname: Zenarosa
mesh_terms: D000328:Adult; D002608:Charities / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006300:Health Services Misuse / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D017057:Medically Uninsured / Q000706:statistics & numerical data*; D008875:Middle Aged; D011320:Primary Health Care / Q000706:statistics & numerical data*; D012189:Retrospective Studies