Hospitalization in an urban homeless population: the Honolulu Urban Homeless Project

Abstract

Objective: To determine the rate and estimate the cost of hospitalization in a defined urban homeless population.

Design: Retrospective chart review.

Setting: Kalihi-Palama Health Clinic Health Care for the Homeless Project, Hawaii State Hospital and seven acute care hospitals in Honolulu, Hawaii.

Patients: A total of 1751 homeless clients contacted between 1 December 1988 and 30 November 1990.

Measurements and main results: A total of 1751 individuals were studied for an aggregate of 871.3 person-years. Five hundred sixty-four hospitalizations were identified: ninety-two to the state psychiatric hospital and 472 to acute care hospitals. The age- and sex-adjusted hospitalization rate for acute care hospitals was 542/1000 person-years (compared with the state rate of 96/1000 person-years). Homeless persons were admitted to acute care hospitals for 4766 days compared with a predicted 640 days. The age- and sex-adjusted rate of admission to the state psychiatric hospital was 105/1000 person-years (compared with the state rate of 0.8/1000 person-years). Homeless persons were admitted to the state psychiatric hospital for 3837 days compared with a predicted 139 days.

Conclusions: Homeless individuals in this study were hospitalized in acute care and psychiatric hospitals far more frequently than were members of the general population.