{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T07:03:13Z","timestamp":1789974193557,"version":"4.0.1"},"reference-count":20,"publisher":"SAGE Publications","issue":"6","license":[{"start":{"date-parts":[[2014,12,1]],"date-time":"2014-12-01T00:00:00Z","timestamp":1417392000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Population Health Management"],"published-print":{"date-parts":[[2014,12]]},"abstract":"<jats:p>\n                    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\u201356 interquartile range), were predominantly male (85.1%), and insured by Medicaid (59.5%). Most (44.2%) visits by homeless frequent users occurred between 1500\u20132259 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. (\n                    <jats:italic toggle=\"yes\">Population Health Management<\/jats:italic>\n                    2014;17:366\u2013371)\n                  <\/jats:p>","DOI":"10.1089\/pop.2013.0118","type":"journal-article","created":{"date-parts":[[2014,5,27]],"date-time":"2014-05-27T15:44:54Z","timestamp":1401205494000},"page":"366-371","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":53,"title":["The Urban Homeless: Super-users of the Emergency Department"],"prefix":"10.1177","volume":"17","author":[{"given":"Bon S.","family":"Ku","sequence":"first","affiliation":[{"name":"Thomas Jefferson University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J. 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Frequent users of the emergency department: a program to improve care and reduce visits. 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National Hospital Ambulatory Medical Care Survey: 2006 emergency department summary. 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