The proposed research deals with health and homelessness in 19 American cities and is occasioned by a major program currently providing primary medical care to homeless individuals. The program is the Health Care for the Homeless (HCH) Project and provides us with the largest epidemiological data resource on the homeless as well as the most unique opportunity to investigate continuity of medical care among the homeless. The research problem is continuity of care, that is, why some homeless persons continue in treatment while others do not. We plan to link client records over the first year of program operation. To assess continuity, we propose a secondary analysis of clients presenting with peripheral vascular disease and related foot disorders (PVD). Two measures of continuity are selected for examination: utilization of health clinics for the PVD condition and timeliness of PVD visits. Continuity will be regressed on client, disease, and organizational variables. Client variables include sex, age, education, physical health condition, and more. Disease variables refer to characteristics of the presenting PVD condition e.g., urgency and severity. Organizational variables include length of time in operation, type of facility, population served, type of attending providers, caseload, presence of outreach efforts, and availability of transportation to other HCH clinics. Findings on the effect of organizational variables on continuity will offer practical information for those delivering health services to the homeless.
