Moore David Thomas, Rosenheck Robert A
The authors are with the Department of Psychiatry, Yale University School of Medicine, New Haven, Connecticut (e-mail:
Psychiatr Serv. 2016 Dec 1;67(12):1340-1347. doi: 10.1176/appi.ps.201500526. Epub 2016 Jul 15.
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.
无家可归的成年人大量使用急诊科（ED）服务。本研究调查了一组长期无家可归者中与中度和高度急诊科使用相关的因素。
一项横断面分析确定了在11个地点参与“帮助终结长期无家可归合作倡议”（CICH）的755名个体队列中与急诊科使用相关的因素。双变量分析确定了与中度和高度急诊科使用相关的社会人口统计学、住房状况、健康状况和服务相关因素。然后使用多元多项模型确定独立危险因素。采用分层回归比较急诊科使用与由社会人口统计学、住房、健康和服务相关特征组成的因素组之间的关联强度。
在三个月的时间里，30%的参与者去过急诊科一到两次（中度急诊科使用），12%的参与者去过三次或更多次（高度急诊科使用）。急诊科使用与健康状况差、使用其他非急诊科服务的关联最为密切，在较小程度上与住房状况有关。
急诊科利用率的增加与一般医疗和精神疾病发病率以及更多地使用非急诊科服务有关。因此，急诊科使用与高需求和高急症相关，并且不会因使用其他服务而得到改善。住房不稳定和无家可归对急诊科使用增加的影响较小。更协调的服务可能更好地满足长期无家可归者复杂的医疗、住房和心理社会需求。
