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Summaries of Independent Scientist (K) Awards

Kushel, Margot

Institution: Regents of the University of California
Grant Title: Improving the Health of Homeless Persons
Grant Number: K08 HS011415-01
Duration: 5 years (2002-2007)
Total Award: $608,500

Project Description: The purpose of the research is to examine the association between housing, case management, and general homeless services and the health care utilization patterns and outcomes of the homeless, as well as the cost-effectiveness of these services. This project has three main goals:

  1. To examine the effects of different levels of community services for the homeless (housing, health care, overall services) on hospitalization and emergency department rates of homeless adults and children.
  2. To examine the cost-effectiveness of case-management as a strategy for improving health outcomes among HIV-infected homeless persons.
  3. To examine health care utilization and public costs of a cohort of homeless persons under two different policy options-supportive housing and usual care.

Career Goals:  Dr. Kushel is an Assistant Professor of Medicine at University of California, Berkeley and San Francisco (UCSF). She is interested in gaining tools necessary to become a leader in health services research and health care policy for the homeless.

Progress to Date:  Dr. Kushel is engaged in her clinical practice one-half day per week. She also teaches residents in clinical medicine, evidence-based medicine and homeless issues. She mentors medical students, residents, and fellows in research. She regularly attends and presents at the Society of General Internal Medicine (SGIM) national meeting, where she co-directs the homeless health care interest group.

Future Plans:  Dr. Kushel's research focuses on understanding the association between homelessness and health service utilization and health care outcomes, with a focus on understanding how policy changes impact health care outcomes. She is interested both in the effects of chronic homelessness and that of housing instability. The following projects are underway:

  1. Is post-emancipation housing status associated with poor health outcomes among youth aging out of the foster care system?
  2. The use and misuse of opioid analgesics in a cohort of HIV-infected homeless and marginally housed persons. (Margot Kushel PI).
  3. The association between housing instability, food insecurity and health care outcomes.

Highlights and Specific Accomplishments:

  • Professional Societies:
    • American College of Internal Medicine.
    • Society for General Internal Medicine.
  • Advisory Boards:
    • Frequent Users of Health Care Initiative.
    • San Francisco Department of Public Health Medical Respite planning committee.
  • Invited Talks:
    • Department of Medicine Grand Rounds, San Francisco General Hospital, Veterans Affairs Medical Center.
    • May 2004 "Homelessness: What's Healthcare got to do with it?"
    • October 2002 "Homelessness: Current Controversies in San Francisco."
    • February 2001. "Health Care Utilization in Homeless Persons."
    • July 1999. "Health Care and the Homeless."
    • Student Health Professionals for Social Responsibility: Violence Prevention Conference. "No Door to Lock: Victimization in the Homeless and Marginally Housed." 2004.
    • Stanford University Medical School Physicians and Social Responsibility. "Health Care Utilization in Homeless Persons." 2000-2004.
    • Grand Rounds: Homelessness: What's Health Care got to do with it?
    • Santa Clara Valley Medical Center , Kaiser San Francisco 2005.
    • Homelessness: Can healthcare providers be part of the solution (March 2006) University of Nevada, Reno. Department of Psychiatry.

K-Generated Publications:

  • Kushel MB, Vittinghoff E, Haas JS. Factors associated with the health care utilization of homeless persons. JAMA 2001;285:200-6.
  • Kushel MB, Perry S, Bangsberg D, et al. Emergency Department Utilization Among the Homeless and Marginally Housed: Results from a community based study. American Journal of Public Health 2002;92:778-84.
  • Kushel MB, Evans JL, Perry S, Robertson M, Moss AR. No door to lock: Victimization Among the Homeless and Marginally Housed. Archives of Internal Medicine 2003;163:2492-9.
  • Walley AY, White MC, Kushel MB, Song YS, Tulsky JP. Knowledge of and interest in Hepatitis C treatment at a methadone clinic. Journal of Substance Abuse Treatment 2005 Mar;28(2):181-7.
  • Tsai M, Weintraub R, Gee L, Kushel MB. Identifying homelessness at an urban public hospital: A moving target? Journal of Health Care for the Poor and Underserved 2005 May;16(2):297-307.
  • Kushel MB, Hahn JA, Evans J, et al. Revolving Doors: Imprisonment Amongst the Homeless and Marginally Housed Population. American Journal of Public Health 2005;95(10):1747-52.
  • Bhandari V, Kushel MB, Price L, Schillinger D. Racial Disparities in Outcomes of Inpatient Stroke Rehabilitation. Archives of Physical Medicine and Rehabilitation 2005: 86(11):2081-6.
  • Kushel MB, Gupta R, Gee L, Haas JS. Housing Instability and Food Insecurity as Barriers to Healthcare: Results from the National Survey of American Families. Journal of  General  Internal Medicine 2006;21:71-7.
  • Hahn JA, Kushel MB, Bangsberg DR, et al. The aging of the homeless population: Fourteen-year trends in San Francisco. Journal of General Internal Medicine 2006 (in press).
  • Kushel MB, Colfax G, Ragland K, et al. Case management is associated with improved antiretroviral adherence and CD4 outcomes in homeless and marginally housed HIV infected individuals. Clinical Infectious Diseases (in press).
  • Kessell E, Bhatia R, Bamberger J, Kushel MB. Public Health Care Utilization in a Cohort of Homeless Adult Applicants to a Supportive Housing Program. Journal of Urban Health (in press).
  • Kushel M, Jain S. Care of the Homeless Patient. in Medical Management of Vulnerable and Underserved Patients: Principles, Practice and Populations, ed. Wheeler M, King T, Fernandez A, Schillinger D, Vilella T, Bindman A, and Grumbach K. Lange, expected publication 2006.

AHRQ Research Portfolio:  Socio-economics of Health Care; Training.
AHRQ Goals:  Efficiency

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