Objective

Homeless patients are a vulnerable population with a higher incidence of using the Emergency Department (ED) for non-crisis 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 utilization for non-emergency 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 versus inappropriate utilization of the ED was determined using the New York University ED Algorithm (NYUA). The association between patients with charity care coverage, PCP assignment status, and appropriate versus inappropriate ED utilization was analyzed and compared.

Results

Following NYUA 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 non-crisis healthcare in the ED (p=0.112). About 50% of inappropriate ED visits and 43.84% of appropriate ED visits occurred in patients with a PCP assignment (p=0.019).

Conclusion

Both charity care homeless patients and those without insurance coverage tend to use the ED for non-crisis care resulting in high rates of inappropriate ED utilization. Simply providing charity care and/or PCP assignment does not seem to sufficiently reduce inappropriate ED utilization in homeless patients.