Abstract In the United States, patient usage of costly emergency departments (EDs) has been portrayed as a major factor contributing to health care expenditures. The homeless are associated with ED frequent users, a population often blamed for inappropriate ED use. This study examined the characteristics and costs associated with homeless ED frequent users. A retrospective cross-sectional review of hospital records for ED visits in 2006 at an urban academic medical center was performed. Frequent users were defined as having greater than 4 ED visits in one year. Homeless status was determined by self-report and review by an interdisciplinary team. A total of 5440 (8.9%) ED visits were made by 542 frequent users, 74 (13.7%) of whom were homeless and made 845 ED visits. Homeless frequent users had a median age of 47 years (39-56 interquartile range), were predominantly male (85.1%), and insured by Medicaid (59.5%). Most (44.2%) visits by homeless frequent users occurred between 1500-2259 hours and had an Emergency Severity Index of Level 3 (55.5%). Sixty-four percent of visits resulted in homeless patients being discharged back to the street; only 4.0% had a specific discharge plan addressing homelessness. Total charges and payments for all homeless frequent users were $4,812,615 and $802,600, respectively. The single top frequent user accrued charges of $482,928. ED frequent users are disproportionately homeless and their costs are significant. ED discharge planning should address the additional risks faced by homeless individuals. ED-based interventions that specifically target the most expensive homeless frequent users may prove to be cost-effective. (Population Health Management 2014;xx:xxx-xxx).
This research output has an Altmetric Attention Score of 16. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 01 October 2026.
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