Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams.
Aged
Delivery of Health Care
/ methods
Female
Ill-Housed Persons
/ statistics & numerical data
Humans
Male
Patient Care Team
/ organization & administration
Patient-Centered Care
/ organization & administration
Primary Health Care
/ methods
Retrospective Studies
Surveys and Questionnaires
United States
United States Department of Veterans Affairs
/ organization & administration
Veterans
/ statistics & numerical data
Journal
Medical care
ISSN: 1537-1948
Titre abrégé: Med Care
Pays: United States
ID NLM: 0230027
Informations de publication
Date de publication:
04 2019
04 2019
Historique:
pubmed:
23
2
2019
medline:
14
6
2019
entrez:
22
2
2019
Statut:
ppublish
Résumé
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. The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care. We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey. 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). Patient experiences in 8 domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus nonpositive. 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). 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.
Sections du résumé
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.
Identifiants
pubmed: 30789541
doi: 10.1097/MLR.0000000000001070
pmc: PMC7773035
mid: NIHMS1651874
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, U.S. Gov't, Non-P.H.S.
Langues
eng
Sous-ensembles de citation
IM
Pagination
270-278Subventions
Organisme : NCATS NIH HHS
ID : KL2 TR002539
Pays : United States
Organisme : HSRD VA
ID : TMI 95-660
Pays : United States
Organisme : NCATS NIH HHS
ID : UL1 TR002538
Pays : United States
Références
JAMA. 2001 Jan 10;285(2):200-6
pubmed: 11176814
Prev Med. 2013 Nov;57(5):658-63
pubmed: 24021993
BMC Psychiatry. 2014 Dec 14;14:353
pubmed: 25496296
JAMA Intern Med. 2014 Aug;174(8):1350-8
pubmed: 25055197
Ann Fam Med. 2011 Mar-Apr;9(2):100-3
pubmed: 21403134
Psychiatr Serv. 2011 Sep;62(9):1054-9
pubmed: 21885584
JAMA Intern Med. 2013 Feb 11;173(3):189-95
pubmed: 23318302
Am J Public Health. 2013 Dec;103 Suppl 2:S331-9
pubmed: 24148052
Am J Public Health. 2012 Dec;102(12):e83-9
pubmed: 23078477
Am J Manag Care. 2013 Jul 01;19(7):e263-72
pubmed: 23919446
Prev Chronic Dis. 2018 Feb 15;15:E23
pubmed: 29451116
Health Commun. 2014;29(7):646-55
pubmed: 24147987
Qual Health Care. 2001 Jun;10(2):90-5
pubmed: 11389317
Diabetes Care. 2014 Sep;37(9):2565-71
pubmed: 24947789
Med Care. 2008 Sep;46(9):963-8
pubmed: 18725851
J Health Care Poor Underserved. 2015 Aug;26(3):1019-31
pubmed: 26320930
Med Care Res Rev. 2014 Oct;71(5):522-54
pubmed: 25027409
Med Care. 2017 Sep;55 Suppl 9 Suppl 2:S104-S110
pubmed: 28806373
Am J Public Health. 2013 Dec;103 Suppl 2:S374-9
pubmed: 24148042
Psychol Serv. 2017 May;14(2):174-183
pubmed: 28481602
Health Serv Res. 2000 Feb;34(6):1273-302
pubmed: 10654830
Med Care. 2012 Nov;50 Suppl:S2-10
pubmed: 23064272
J Ment Health Policy Econ. 2001 Jun 1;4(2):55-63
pubmed: 11967466
Med Care. 2013 Jun;51(6):532-9
pubmed: 23673395
Perspect Med Educ. 2016 Jun;5(3):154-62
pubmed: 27277430
Health Serv Res. 2013 Jun;48(3):992-1017
pubmed: 23134588
PLoS One. 2015 Jul 14;10(7):e0132664
pubmed: 26172386
Med Care. 2018 Jul;56(7):610-618
pubmed: 29762272
J Clin Epidemiol. 2011 Jul;64(7):749-59
pubmed: 21208778
Health Serv Res. 2009 Apr;44(2 Pt 1):542-61
pubmed: 19040424
Med Decis Making. 2015 Jan;35(1):114-31
pubmed: 25351843
Am J Med Qual. 2010 Jan-Feb;25(1):42-50
pubmed: 19855046
Prev Chronic Dis. 2016 Mar 31;13:E44
pubmed: 27032987
Patient Educ Couns. 2011 Nov;85(2):143-7
pubmed: 21035296
Med Care. 2014 Apr;52(4):328-35
pubmed: 24848206
Med Care. 2014 Aug;52(8):734-42
pubmed: 25023918
Subst Abus. 2018;39(3):354-360
pubmed: 29412071
J Gen Intern Med. 2011 Nov;26 Suppl 2:683-8
pubmed: 21989622
Clin Ther. 2014 May;36(5):689-696.e1
pubmed: 24811752
J Health Care Poor Underserved. 2017;28(3):1151-1164
pubmed: 28804084
Patient Prefer Adherence. 2016 Feb 12;10:153-8
pubmed: 26929607