PREDICTORS OF EMERGENCY ROOM USE BY HOMELESS ADULTS IN NEW-YORK-CITY - THE INFLUENCE OF PREDISPOSING, ENABLING AND NEED FACTORS

Employing data from a 1987 shelter survey of 1260 homeless adults in N ew York City, multivariate models of emergency room (ER) use are devel oped which include an array of risk factors for visiting a hospital ER including health and mental health problems, victimization and injuri es. The study's primary goal is to identify factors that predict ER us e in this population. Multivariate logistic and linear regression mode ls were tested separately for men and women predicting three outcomes: any use of the ER during the past 6 months, use of the ER for injurie s vs all other reasons (given any ER use), and the number of ER visits (given any ER use). Lower alcohol dependence, health symptoms and inj uries were strong predictors for both men and women; other significant predictors differed markedly by gender. Both models were highly signi ficant and produced strikingly high risk profiles. A high prevalence o f victimization and injuries underlies ER use among the homeless. Base d upon the findings, we recommend expanded health and victim services as well as preventive measures. Until primary care becomes available f or this population, we advise against policies that discourage ER use by the homeless.