title: Factors Affecting Emergency Department Use by a Chronically Homeless Population.
abstract: Homeless adults make extensive use of emergency department (ED) services. This study examined factors associated with moderate and high ED use in a cohort of chronically homeless individuals.
  
  
  
  A cross-sectional analysis identified factors related to ED use in a cohort of 755 individuals at 11 sites at entry into the Collaborative Initiative to Help End Chronic Homelessness (CICH). Bivariate analyses identified sociodemographic, housing status, health status, and service-related factors associated with moderate and high ED use. Independent risk factors were then identified by using a multivariate multinomial model. Hierarchical regression was used to compare the strengths of association between ED use and blocks of factors composed of sociodemographic, housing, health, and service-related characteristics.
  
  
  
  In a three-month period, 30% of participants visited the ED one or two times (moderate ED use) and 12% visited three or more times (high-ED use). ED use was most strongly associated with poor health and utilization of other non-ED services and to a lesser extent with housing status.
  
  
  
  Increased ED utilization was associated with both general medical and psychiatric morbidity and greater use of non-ED services. Thus ED use was related to high need and acuity and was not ameliorated by use of other services. Housing instability and homelessness contributed less robustly to increased ED use. More coordinated services may better address the complex medical, housing, and psychosocial needs of chronically homeless individuals.
authors.affiliation: The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: david.moore@yale.edu ). Dr. Rosenheck is also with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut.
authors.forename: David Thomas
authors.initials: DT
authors.lastname: Moore
authors.affiliation: The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail: david.moore@yale.edu ). Dr. Rosenheck is also with the U.S. Department of Veterans Affairs New England Mental Illness Research, Education and Clinical Center, West Haven, Connecticut.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Rosenheck
mesh_terms: D000328:Adult; D003430:Cross-Sectional Studies; D004636:Emergency Service, Hospital / Q000191:economics / Q000706:statistics & numerical data*; D005260:Female; D006304:Health Status; D006703:Ill-Housed Persons / Q000523:psychology* / Q000706:statistics & numerical data*; D006798:Housing; D006801:Humans; D016015:Logistic Models; D008297:Male; D001523:Mental Disorders / Q000191:economics / Q000453:epidemiology* / Q000628:therapy; D008875:Middle Aged; D015999:Multivariate Analysis; D012307:Risk Factors; D012944:Social Support; D014481:United States / Q000453:epidemiology