Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes

Abstract

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 self-management 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.

Primary Care for Homeless Veterans: A Systematic Review of the Homeless Patient Aligned Care Team (HPACT)

“…Multiple studies focused on patient experience and engagement. Three studies suggest that care in an HPACT was associated with improved patient experience for homeless Veterans compared to traditional VA care settings (18, 19), especially for those Veterans with severe psychiatric symptoms. (20) Kertesz and colleagues in surveying about 600 homeless-experienced patients in 3 Veteran’s Affairs (VA) mainstream primary care settings, a Homeless-PACT VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program (HCHP) in Massachusetts reported that highly tailored primary care services were associated with decreased odds of unfavorable experiences in the domains of patient-clinician relationship, cooperation, and access or coordination compared to mainstream VA primary cares sites, whereas the VA HPACT site attained intermediate results.…”

Prevalence of and Risk Factors Associated With Nonfatal Overdose Among Veterans Who Have Experienced Homelessness

“…However, this response rate is comparable to that obtained in an evaluation of national VA primary care (47%), 51 and roughly 2-fold that obtained by VA's primary care survey of veterans who have experienced homelessness. 6 Furthermore, since we had access to rich data from VA records to compare respondents and nonrespondents, we were able to weight our analyses by the propensity to respond, which at least somewhat reduces the risk of nonresponse bias. It is also important to highlight that there have been few recent efforts to survey homeless-experienced populations on a national basis, 52,53 so this study likely represents the best available data to study these questions in this population.…”

A research proposal testing a new model of ambulation activity among long-term care residents with dementia/cognitive impairment: the study protocol of a prospective longitudinal natural history study

“…Thus, there is a community of VA researchers who will be able to utilize and distribute findings from this study. In addition, Patient Aligned Care Teams (PACTs) which are based on the patient-centered medical home model [55], focus on care coordination, health care access, providing comprehensive care, and integrating psychosocial and environmental determinants of health [56]. These PACTs enable earlier adoption of study findings—namely how behavioral information may be used to preserve the functional status of NH residents.…”