Findings of a national dataset analysis on the visits of homeless patients to US emergency departments during 2005-2015

To our knowledge, there has been limited description of emergency department (ED) visits involving homeless patients over the last decade. Our study aims to analyze US national survey data to elucidate the differences between homeless and non-homeless patients’ ED visits in terms of patient demographics, resource utilization, and diagnoses received. This was a retrospective study using data from the National Hospital Ambulatory Medical Care Survey (NHAMCS) from 2005 until 2015. Patient visits were classified as homeless or non-homeless based on survey data; appropriate statistical analyses were subsequently performed to compare these groups in terms of patient demographics, geography, payment method, resource utilization/diagnostic service use, as well as both psychiatric and non-psychiatric diagnoses received in the ED. NHAMCS data from 2005 to 2015 were aggregated. In total, 303,326 patient visits were included, which represent an estimated 1.30 billion ED visits over this period. Of these, 2750 encounters were by homeless people, representing 8,781,925 ED visits. Compared with non-homeless visits, homeless patients were disproportionately male, black, non-Hispanic, and seen in large metropolitan areas or the Western/Southern US. Homeless visits were more likely to be related to an injury (47.5% vs. 33.8%), related to an assault (4.2% vs. 1.3%), or self-inflicted (4.8% vs 0.84%). Homeless patients were also more likely to have been seen in the same ED within 72 h (7.3% vs. 3.9%) compared with non-homeless patients (3.9%, 95% confidence interval [CI]: 3.5–4.4) and were seen an average of 5.7 times (95% CI: 4.7–6.8) in the same ED over the preceding 12 months, with non-homeless patients seen an average of 3.2 times (95% CI: 3.1–3.4). Homeless patients were more likely to be admitted to the hospital (14.9% vs. 11.2%) and, when admitted, spent an average of 6.3 days in the hospital (95% CI: 5.6–7.1) compared with non-homeless patients at 5.2 (95% CI: 5.1–5.3). In total, 28.4% of homeless patients received a psychiatric diagnosis (95% CI: 25.8–31.2) compared with 5.4% for non-homeless patients (95% CI: 5.2–5.7, P