Margot Kushel, MD

Professor

Margot Kushel, MD is a Professor of Medicine in the Division of General Internal Medicine at Zuckerberg San Francisco General Hospital and Trauma Center and the Director of the UCSF Center for Vulnerable Populations. Margot's research focuses on reducing the burden of homelessness on health through examining efforts to prevent and end homelessness and mitigating the effects of housing instability on health care outcomes. She uses a variety of research methodologies with an aim towards informing the development of programs and policies to end homelessness via understanding the complex interactions between health and housing. She has a particular interest in homelessness in older adults and homelessness in medically complicated individuals. She is the PI of an NIA funded R01 that developed the HOPE HOME (Health Outcomes in Populations Experiencing Homelessness in Older Middle agE) cohort, an ongoing longitudinal cohort study examining the causes and effects of homelessness on adults aged 50 and over in Oakland, CA. She is the Co-PI (with Kelly Knight, PhD) of a companion study examining involvement of families in rehousing older adults experiencing homeless. Passionate about training the next generation of researchers seeking to improve outcomes in vulnerable populations, she is the PI of a K24 award from NIA to mentor junior investigators in aging in vulnerable populations and directs the UCSF Primary Care Research Fellowship. Margot works with diverse stakeholders to implement programmatic and policy changes based on her research. She maintains an active clinical practice at ZSFG in both primary care and inpatient medicine.
Education
2019 - Diversity, Equity, and Inclusion Champion Training, University of California
Fellow, 2001 - General Internal Medicine, University of California, San Francisco
Chief Resident, 1999 - Medicine, University of California, San Francisco
Resident, 1998 - Medicine/Primary Care, University of California, San Francisco
Intern, 1996 - Medicine/Primary Care, University of California, San Francisco
MD, 1995 - , Yale School of Medicine
AB, 1990 - English, Harvard University
Websites
Publications
  1. Coronavirus Disease 2019 (COVID-19) Outbreak in a San Francisco Homeless Shelter.
  2. Association of Homelessness with Hospital Readmissions-an Analysis of Three Large States.
  3. Database Inaccuracies and Disparities in Care Among Homeless Adults Hospitalized for Cardiovascular Conditions.
  4. Barriers and Solutions to Advance Care Planning among Homeless-Experienced Older Adults.
  5. Risk Factors for Falls in Older Adults Experiencing Homelessness: Results from the HOPE HOME Cohort Study.
  6. "We Really Help, Taking Care of Each Other": Older Homeless Adults as Caregivers.
  7. Racial discrimination in the life course of older adults experiencing homelessness: results from the HOPE HOME study.
  8. Health Literacy Matters More Than Experience for Advance Care Planning Knowledge Among Older Adults.
  9. Unmet mental health and substance use treatment needs among older homeless adults: Results from the HOPE HOME Study.
  10. Trajectories of functional impairment in homeless older adults: Results from the HOPE HOME study.
  11. Adults with Housing Insecurity Have Worse Access to Primary and Preventive Care.
  12. Factors associated with food insecurity among older homeless adults: results from the HOPE HOME study.
  13. Persistent Homelessness and Violent Victimization Among Older Adults in the HOPE HOME Study.
  14. High perceived social support and hospital readmissions in an older multi-ethnic, limited English proficiency, safety-net population.
  15. Sources and Impact of Time Pressure on Opioid Management in the Safety-Net.
  16. Persistent Food Insecurity Is Associated with Adverse Mental Health among Women Living with or at Risk of HIV in the United States.
  17. Mobile Phone, Computer, and Internet Use Among Older Homeless Adults: Results from the HOPE HOME Cohort Study.
  18. Oral health and access to dental care among older homeless adults: results from the HOPE HOME study.
  19. Homelessness: A Potent Risk Factor for Readmission.
  20. 'The thing that really gets me is the future': Symptomatology in Older Homeless Adults in the HOPE HOME Study.
  21. Advance Care Planning for Older Homeless-Experienced Adults: Results from the Health Outcomes of People Experiencing Homelessness in Older Middle Age Study.
  22. Mobile Phone, Computer, and Internet Use among Older Homeless Adults: Results from the HOPE HOME Study (Preprint).
  23. Hepatitis A Outbreak in California - Addressing the Root Cause.
  24. Food Insecurity is Associated with Poor HIV Outcomes Among Women in the United States.
  25. Physical, Psychological, Social, and Existential Symptoms in Older Homeless-Experienced Adults: An Observational Study of the Hope Home Cohort.
  26. Older African American Homeless-Experienced Smokers' Attitudes Toward Tobacco Control Policies-Results from the HOPE HOME Study.
  27. Mobilizing cross-sector community partnerships to address the needs of criminal justice-involved older adults: a framework for action.
  28. "The land of the sick and the land of the healthy": Disability, bureaucracy, and stigma among people living with poverty and chronic illness in the United States.
  29. Geriatric Conditions in a Population-Based Sample of Older Homeless Adults.
  30. Factors associated with cognitive impairment in a cohort of older homeless adults: Results from the HOPE HOME study.
  31. Opioid pharmacovigilance: A clinical-social history of the changes in opioid prescribing for patients with co-occurring chronic non-cancer pain and substance use.
  32. Characteristics and Factors Associated With Pain in Older Homeless Individuals: Results From the Health Outcomes in People Experiencing Homelessness in Older Middle Age (HOPE HOME) Study.
  33. The risks of opioid treatment: Perspectives of primary care practitioners and patients from safety-net clinics.
  34. Emergency Department Use in a Cohort of Older Homeless Adults: Results From the HOPE HOME Study.
  35. Permanent Supportive Housing for Homeless People - Reframing the Debate.
  36. Factors associated with substance use in older homeless adults: Results from the HOPE HOME study.
  37. Out-of-Network Emergency Department Use among Managed Medicaid Beneficiaries.
  38. Provider Experiences With the Identification, Management, and Treatment of Co-occurring Chronic Noncancer Pain and Substance Use in the Safety Net.
  39. The effectiveness of tobacco control policies on vulnerable populations in the USA: a review.
  40. Things Fall Apart: Preventing High Readmission Rates Among Homeless Adults.
  41. Childhood Adversities Associated with Poor Adult Mental Health Outcomes in Older Homeless Adults: Results From the HOPE HOME Study.
  42. The Effectiveness of Emergency Department Visit Reduction Programs: A Systematic Review.
  43. Pathways to Homelessness among Older Homeless Adults: Results from the HOPE HOME Study.
  44. Tobacco Cessation Behaviors Among Older Homeless Adults: Results From the HOPE HOME Study.
  45. Residential patterns in older homeless adults: Results of a cluster analysis.
  46. Primary care providers' experiences with urine toxicology tests to manage prescription opioid misuse and substance use among chronic noncancer pain patients in safety net health care settings.
  47. Hospitalization-Associated Disability in Adults Admitted to a Safety-Net Hospital.
  48. The Effect of a Care Transition Intervention on the Patient Experience of Older Multi-Lingual Adults in the Safety Net: Results of a Randomized Controlled Trial.
  49. Food Insecurity is Longitudinally Associated with Depressive Symptoms Among Homeless and Marginally-Housed Individuals Living with HIV.
  50. The First Step is the Hardest: Overcoming Barriers to Primary Care.
  51. Functional disability in late-middle-aged and older adults admitted to a safety-net hospital.
  52. The health of homeless people in high-income countries: descriptive epidemiology, health consequences, and clinical and policy recommendations.
  53. Support from hospital to home for elders: a randomized trial.
  54. Improving care for hospitalized, opioid-dependent patients: a promising start.
  55. Non-medical use of non-opioid psychotherapeutic medications in a community-based cohort of HIV-infected indigent adults.
  56. Opioid analgesic misuse is associated with incomplete antiretroviral adherence in a cohort of HIV-infected indigent adults in San Francisco.
  57. "Missing pieces"--functional, social, and environmental barriers to recovery for vulnerable older adults transitioning from hospital to home.
  58. Smoking behaviors in a community-based cohort of HIV-infected indigent adults.
  59. Food insecurity and HIV clinical outcomes in a longitudinal study of urban homeless and marginally housed HIV-infected individuals.
  60. Food insecurity and risky sexual behaviors among homeless and marginally housed HIV-infected individuals in San Francisco.
  61. Housing instability and incident hypertension in the CARDIA cohort.
  62. Wang et al. Respond.
  63. Opioid analgesic misuse in a community-based cohort of HIV-infected indigent adults.
  64. Food insecurity is associated with greater acute care utilization among HIV-infected homeless and marginally housed individuals in San Francisco.
  65. Primary care providers' views on chronic pain management among high-risk patients in safety net settings.
  66. Engaging individuals recently released from prison into primary care: a randomized trial.
  67. Do patients know they are on pain medication agreements? Results from a sample of high-risk patients on chronic opioid therapy.
  68. Specific psychiatric correlates of acute care utilization among unstably housed HIV-positive adults.
  69. Older homeless adults: can we do more?
  70. Conceptual framework for understanding the bidirectional links between food insecurity and HIV/AIDS.
  71. Implementation of an electronic referral system for outpatient specialty care.
  72. Occurrence and characteristics of chronic pain in a community-based cohort of indigent adults living with HIV infection.
  73. Aberrant behaviors with prescription opioids and problem drug use history in a community-based cohort of HIV-infected individuals.
  74. Primary care providers’ judgments of opioid analgesic misuse in a community-based cohort of HIV-infected indigent adults.
  75. Is primary care providers' trust in socially marginalized patients affected by race?
  76. Physician trust in the patient: development and validation of a new measure.
  77. A marginal structural model to estimate the causal effect of antidepressant medication treatment on viral suppression among homeless and marginally housed persons with HIV.
  78. Health care access and utilization in older versus younger homeless adults.
  79. Reply to Dr. Francis Tayie and Dr. Claire Zizza.
  80. Coming home: health status and homelessness risk of older pre-release prisoners.
  81. Late presentation for human immunodeficiency virus care in the United States and Canada.
  82. Evaluating electronic referrals for specialty care at a public hospital.
  83. Practice profile. A safety-net system gains efficiencies through 'eReferrals' to specialists.
  84. Transitions clinic: creating a community-based model of health care for recently released California prisoners.
  85. Food insecurity is associated with chronic disease among low-income NHANES participants.
  86. Trends in multidrug treatment failure and subsequent mortality among antiretroviral therapy-experienced patients with HIV infection in North America.
  87. Non-English speakers attend gastroenterology clinic appointments at higher rates than English speakers in a vulnerable patient population.
  88. Food insecurity among homeless and marginally housed individuals living with HIV/AIDS in San Francisco.
  89. Not perfect, but better: primary care providers' experiences with electronic referrals in a safety net health system.
  90. From homeless to hopeless and healthless?: the health impacts of housing challenges among former foster care youth transitioning to adulthood in California.
  91. Association between the level of housing instability, economic standing and health care access: a meta-regression.
  92. Implementation of the Medicare Part D prescription drug benefit is associated with antiretroviral therapy interruptions.
  93. Associations between housing instability and food insecurity with health care access in low-income children.
  94. Homelessness and health care access after emancipation: results from the Midwest Evaluation of Adult Functioning of Former Foster Youth.
  95. Food insecurity is associated with diabetes mellitus: results from the National Health Examination and Nutrition Examination Survey (NHANES) 1999-2002.
  96. Hospitalized younger: a comparison of a national sample of homeless and housed inpatient veterans.
  97. End-of-life care for homeless patients: "she says she is there to help me in any situation".
  98. Public health care utilization in a cohort of homeless adult applicants to a supportive housing program.
  99. BRIEF REPORT: the aging of the homeless population: fourteen-year trends in San Francisco.
  100. Case management is associated with improved antiretroviral adherence and CD4+ cell counts in homeless and marginally housed individuals with HIV infection.
  101. Housing instability and food insecurity as barriers to health care among low-income Americans.
  102. Racial disparities in outcomes of inpatient stroke rehabilitation.
  103. Revolving doors: imprisonment among the homeless and marginally housed population.
  104. Identifying homelessness at an urban public hospital: a moving target?
  105. Knowledge of and interest in hepatitis C treatment at a methadone clinic.
  106. Health care lobbying: time to make patients the special interest.
  107. No door to lock: victimization among homeless and marginally housed persons.
  108. Emergency department use among the homeless and marginally housed: results from a community-based study.
  109. Factors associated with the health care utilization of homeless persons.