Compared with nonhomeless patients, homeless patients are a special population with more barriers to appropriate access to preventive health care services such as personal, bureaucratic, programmatic, and financial factors. As such, these patients tend to inappropriately use the emergency department (ED) more often than the general population. Inappropriate ED use is operationally defined as those patients who present with clinical signs and symptoms that are categorized as nonurgent and could be handled in a nonemergent manner such as in a primary care physician (PCP) clinic. Anecdotal evidence in our ED in Texas and the empirical evidence from other studies show that homeless patients tend to be high ED users. They are older, more often male, and their visits tend to result in a higher rate of hospitalization. A tendency toward inappropriate ED use by homeless patients is documented in the literature in association with ED overcrowding resulting in negative prognostic outcomes