Journal
MEDICAL CARE
Volume 57, Issue 4, Pages 270-278Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/MLR.0000000000001070
Keywords
homelessness; patient experience; primary care; veterans
Categories
Funding
- Department of Veterans Affairs, Veterans Health Administration, National Center on Homelessness among Veterans
- VISN19 and VA Salt Lake City Health Care System's Vulnerable Veteran-Innovative PACT (VIP) Initiative
- VA Office of Academic Affiliations Post-Doctoral Fellowship in Medical Informatics [TMI 95-660]
- National Center for Advancing Translational Sciences of the National Institutes of Health [UL1TR002538, KL2TR002539]
- VA Health Services Research & Development Grants [IIR 15-095, IIR 12-084]
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Background: In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans. Objective: The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care. Research Design: We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey. Subjects: Homeless-experienced survey respondents enrolled in H-PACT (n=251) or standard primary care in facilities with H-PACT available (n=1527) and facilities without H-PACT (n=10,079). Measures: Patient experiences in 8 domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus nonpositive. Results: H-PACT patients were less likely than standard primary care patients to be female, have 4-year college degrees, or to have served in recent military conflicts; they received more primary care visits and social services. H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access [adjusted risk difference (RD)=17.4], communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and selfmanagement support (RD=4.6). Conclusions: Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, when compared with standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other health care settings.
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