Health care utilization among homeless adults prior to death

This study characterizes health care utilization prior to death in a group of 558 homeless adults in Boston. In the year before death, 27 percent of d ecedents had no outpatient visits, emergency department visits, or hospital izations except those during which death occurred. However, 21 percent of h omeless decedents had a health care contact within one month of death, and 21 percent had six or more outpatient visits in the year before death. Inje ction drug users and persons with HIV infection were more likely to have ha d contact with the health care system. This study concludes that homeless p ersons may be underusing health care services even when they are at high ri sk of death. Because a subset of homeless persons had extensive health care contacts prior to death, opportunities to prevent deaths may have been mis sed, and some deaths may not have been preventable through medical interven tion.