Health
Care for the Homeless
711 West Capitol Drive
Milwaukee, Wisconsin 53206
Contact: Alice Fletcher
Phone: (414) 374-2400
Key words: health status; chronic conditions
(e.g., asthma, diabetes, hypertension)
The purpose of this study was to identify
core measures that might be used as indicators
in evaluating health care provided to
homeless clients by observing a sample
of patients with chronic conditions commonly
affecting homeless people and their impact
on patients overall health status.
METHODS
Data was collected on 180 homeless adults
who had been diagnosed with one of three
chronic conditionshypertension, non-insulin
dependent diabetes, or asthmaand were
seen at three sites in the city of Milwaukee.
Study participants were originally identified
through a retrospective chart review.
Specific measures observed with regard
to these chronic conditions included the
following: compliance with medication
and treatment regimen; number of scheduled
appointments kept; level of client understanding
of condition and medication regimen; and
client satisfaction.
Program goals for patients health status
related to the three chronic conditions
observed and included the following: 1)
(re: diabetes) achievement and maintenance
of a two point decrease in glycosolated
hemoglobin level after 3 months; 2) (re:
hypertension) maintenance of blood pressure
below 140/90 mmHg while concomitantly
controlling other modifiable cardiovascular
risk factors; and 3) (re: asthma) no need
for hospitalization, emergency nebulizer
treatment, or an emergency room visit
for 3 months.
Fifty-one percent of diabetic patients
experienced a two point decrease in their
glycosolated hemoglobin level after 3
months. Fifty-eight percent of hypertensive
patients maintained their blood pressure
under 140/90 while concomitantly controlling
other modifiable cardiovascular risk factors.
Fifty-eight percent of asthmatic patients
had no need for hospitalization, emergency
nebulizer treatment, or an emergency room
visit for 3 months. Ten percent of diabetic
patients met personal goals for control
of their condition. Twenty-six percent
of hypertensive patients considered themselves
successful in reducing their sodium intake.
Twenty-two percent of asthmatic patients
utilized information from patient education
materials regarding the use of nebulizers
and spacer inhalers.
The overall results of the study were
not as good as program staff expected.
Some variations in the results may have
been due to differences in completeness
of documentation by health care providers.
Particularly disappointing were those
results that were directly related to
the personal goals and actions of patients.
One reason for the apparent lack of utilization
of information from patient education
materials may have been some patients_
illiteracy. Although the original study
plan included having approximately equal
numbers of patients in each of the three
chronic condition categories across all
three sites, this did not turn out to
be the case. Attempts made to adjust the
balance were
unsuccessful.
Further study is needed. To allow for
better implementation and monitoring in
future studies, studies may be limited
to one site at a time. To help standardize
documentation in medical records, flow
sheets developed during this study will
be used routinely in the future. An audit
is planned for a few months after the
complete implementation of the flow sheets.
