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Summaries of Independent Scientist (K) Awards

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Kushel, Margot

Institution: University of California, San Francisco (UCSF)
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 was to examine the association between housing, case management, and general homeless services and the health care utilization patterns and outcomes of the homeless, then looks at the cost-effectiveness of these services.  There were three main goals:

  1. To examine the effects of different levels of community services for the homeless (house, 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 UCSF. She received her MD from Yale University and served her residency in Primary Care/Internal Medicine at UCSF. She has become a leader in health services research and health care policy for the homeless.

Progress to Date: This grant has been completed. Dr. Kushel found homeless populations are marked by high rates of victimization and past history of incarceration. Further, housing instability is associated with poor access to care. While supportive housing is an effective mechanism to maintain housing, it did not decrease acute health care utilization.

Highlights and Specific Accomplishments:

  • Invited Talk: Urban Homelessness and Public Policy Solutions.  UC Berkeley School of Public Policy (2001).
  • Medical Grand Rounds, San Francisco General Hospital, "Health Care Utilization in Homeless Persons (2001)."

K-Generated Publications:

Kushel M, Bindman AB.  Health care lobbying:  Time to make patients the special interest.  American  Journal of  Medicine 2004. 116:496-97.

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. 16(2):297-307.

Kushel MB, Hahn JA, Evans J, Bangsberg D, Moss AR. Revolving doors: Imprisonment amongst the homeless and marginally housed population.American Journal of Public Health 2005. 95(10):1747-52.

Kushel MB, Gupta R, Gee L, Haas JS. Housing instability and food insecurity as barriers to healthcare among low-income Americans. Journal of General Internal Medicine 2006. 21(1):71-7.

Kushel MB, Evans JL, Perry S, et al. No door to lock: Victimization among homeless and marginally housed persons. Archives of Internal Medicine 2003. 163(2):2492-99.

Walley AY, White MC, Kushel MB, et al. Knowledge of and interest in hepatitis C treatment at a methadone clinic. Journal of Substance Abuse Treatment 2005. 28(2):181-87.

Hahn JA, Kushel MB, Bangbert DR, et al. Brief report: The aging of the homeless population: Fourteen-year trends in San Francisco.  Journal of General Internal Medicine 2006. 32(7):775-78.

Kushel MB, Colfax G, Ragland K, et al. Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection. Clinical Infectious Disease 2006. 43(2):234-42.

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