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ETD Abstract Container

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Health Care Utilization by the Homeless Services Population

Howe, Evan Cecil
http://rave.ohiolink.edu/etdc/view?acc_num=case1247001049

Abstract Details

2009, Doctor of Philosophy, Case Western Reserve University, Epidemiology and Biostatistics.
This dissertation explores three fundamental, yet often ignored, question s in health services research of the homeless population: who the health care for the homeless population is, where this population receives health care services, and why different settings of care are utilized. This study has three aims. In the first aim, we examine the similarity in health care utilization between the literally homeless and others who homeless services to understand if a broader understanding of the homeless population might be appropriate. In the second aim, we attempt to identify unique sub-groups within the homeless services population based on the setting in which health care services are utilized and correlate these to individual characteristics. In the third aim, we develop a conceptual model to describe what factors affect the setting in which health care is received. Methods: Individuals were recruited from homeless shelters, meal sites, and drop in centers. Surveys, interviews, and focus groups were used to collect data from this population. Analysis proceeded using both quantitative (bivariate analyses, social network techniques, geographic data analysis techniques) and qualitative (template analysis) analysis techniques to explore the study population and develop the constructs of this model. Results: The health care utilization patterns of the literally homeless individuals who use services at homeless service sites are distinct from those of the non-homeless individuals who use non-health care services at these same sites. The patterns of health care utilization do not indicate a set of discrete subgroups but rather an interconnected group of individuals who use multiple health care sites. These sites are organized along a core-periphery structure with core health care for the homeless sites connected to one another through overlapping patient populations. Perception of system access characteristics was the most influential factor in deciding where to seek health care services. Conclusions: Health care utilization in the homeless population involves seeking care from multiple health care providers. In order to more effectively structure care, these service providers should increase joint planning and communication and examine ways to design systems of care that will direct individuals to appropriate and cost-effective sources of care.
Mendel Singer, PhD (Committee Chair)
David Litaker, MD, PhD (Committee Member)
Joseph Sudano, PhD (Committee Member)
Henry Ng, MD (Committee Member)
Cynthia Vrabel, MD (Committee Member)
222 p.
Health Care
homeless; health care; soup-kitchen; social network analysis; GIS; template analysis

Recommended Citations

Citations

  • Howe, E. C. (2009). Health Care Utilization by the Homeless Services Population [Doctoral dissertation, Case Western Reserve University]. OhioLINK Electronic Theses and Dissertations Center. http://rave.ohiolink.edu/etdc/view?acc_num=case1247001049

    APA Style (7th edition)

  • Howe, Evan. Health Care Utilization by the Homeless Services Population. 2009. Case Western Reserve University, Doctoral dissertation. OhioLINK Electronic Theses and Dissertations Center, http://rave.ohiolink.edu/etdc/view?acc_num=case1247001049.

    MLA Style (8th edition)

  • Howe, Evan. "Health Care Utilization by the Homeless Services Population." Doctoral dissertation, Case Western Reserve University, 2009. http://rave.ohiolink.edu/etdc/view?acc_num=case1247001049

    Chicago Manual of Style (17th edition)

case1247001049
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© 2009, all rights reserved.
This open access ETD is published by Case Western Reserve University School of Graduate Studies and OhioLINK.