Admission decisions and outcomes of community-acquired pneumonia in the homeless population: a review of 172 patients in an urban setting.

OBJECTIVES: 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). METHODS: We compared homeless (n = 172) and nonhomeless (n = 1897) patients presenting to a Salt Lake City, Utah, emergency department with CAP from 1996 to 2006. In the homeless cohort, we measured referral from and follow-up with the local homeless health care clinic and arrangement of medical housing. RESULTS: Homeless patients were younger (44 vs 59 years; P < .001) and had lower CURB-65 scores and higher hospitalization risk (severity-adjusted odds ratio = 1.89; 95% confidence interval = 1.33, 2.69) than did nonhomeless patients, with a similar length of stay, median inpatient cost, and median outpatient cost, even after severity adjustment. Of homeless patients, 22% were referred from the homeless health care clinic to the emergency department; 54% of outpatients and 51% of hospital patients were referred back to the clinic, and medical housing was arranged for 23%. CONCLUSIONS: 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.