American journal of public health
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A homeless mortality surveillance system identifies emerging trends in the health of the homeless population and provides this information to key stakeholders in a timely and ongoing manner to effect evidence-based, programmatic change. We describe the first 5 years of the New York City homeless mortality surveillance system and, for the first time in peer-reviewed literature, illustrate the impact of key elements of sustained surveillance (i.e., timely dissemination of aggregate mortality data and real-time sharing of information on individual homeless decedents) on the programs of New York City's Department of Homeless Services. These key elements had a positive impact on the department's programs that target sleep-related infant deaths and hypothermia, drug overdose, and alcohol-related deaths among homeless persons.
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We systematically reviewed the health and social science literature on access to and use of information technologies by homeless persons by searching 5 bibliographic databases. Articles were included if they were in English, represented original research, appeared in peer-reviewed publications, and addressed our research questions. ⋯ Homeless persons used technologies for a range of purposes, some of which were health related. Many homeless persons had access to information technologies, suggesting possible health benefits to developing programs that link homeless persons to health care through mobile phones and the Internet.
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We sought to understand interpersonal and systems-level factors relevant to delivering health care to emergency department (ED) patients who are homeless. ⋯ Our study revealed practical and philosophical tensions in providing social care to patients in the ED who are homeless. Screening for homelessness in the ED and admission practices for patients who are homeless are important areas for future research and intervention with implications for health care costs and patient outcomes.
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We compared admission rates, outcomes, and performance of the CURB-65 mortality prediction score of homeless patients and nonhomeless patients with community-acquired pneumonia (CAP). ⋯ A large cohort of homeless patients with CAP demonstrated higher hospitalization risk than but similar length of stay and costs as nonhomeless patients. The strong relationship between the hospital and homeless health care clinic may have contributed to this finding.
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Permanent supportive housing (PSH) is an intervention to address long-term homelessness. Evidence has resulted in a shift in US policy toward using PSH rather than shelters and transitional housing. ⋯ Based on diverse areas of research, we argue that in addition to improved access to quality health care, social determinants of health (including housing itself, neighborhood characteristics, and built environment) affect health outcomes. We identify implications for practice and research, and conclude that federal and local efforts to end long-term homelessness can interact with concurrent efforts to build healthy communities.