American journal of public health
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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.
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We identified predictors of emergency department (ED) use among a population-based prospective cohort of homeless adults in Toronto, Ontario. ⋯ Among homeless adults with universal health insurance, a small subgroup accounted for the majority of visits to emergency services. Frequent use was driven by multiple predisposing, enabling, and need factors.
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Randomized Controlled Trial
Housing first improves residential stability in homeless adults with concurrent substance dependence and mental disorders.
We examined the relationship between substance dependence and residential stability in homeless adults with current mental disorders 12 months after randomization to Housing First programs or treatment as usual (no housing or support through the study). ⋯ People with mental disorders might achieve similar levels of housing stability from Housing First regardless of whether they experience concurrent substance dependence.
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We examined the empirical link between money mismanagement and subsequent homelessness among veterans. ⋯ Money mismanagement, reported by a substantial number of veterans, was related to a higher rate of subsequent homelessness. The findings have implications for policymakers and clinicians, suggesting that financial education programs offered by the US Departments of Defense and Veterans Affairs may be targeted to effectively address veteran homelessness.