Dataset Information

Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams.

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.

SUBMITTER: Jones AL

PROVIDER: S-EPMC7773035 | biostudies-literature | 2019 Apr

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams.

Jones Audrey L AL Hausmann Leslie R M LRM Kertesz Stefan G SG Suo Ying Y Cashy John P JP Mor Maria K MK Pettey Warren B P WBP Schaefer James H JH Gordon Adam J AJ Gundlapalli Adi V AV

Medical care 20190401 4

<h4>Background</h4>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.<h4>Objective</h4>The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care.<h4>Research design</h4>We used multivariable logistic regressions to estimate differences in the probabilit ...[more]

PMID: 30789541

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Project description:ObjectivesThe homeless population is aging, and their use of nursing homes is not well understood. We compared comorbidities (substance use, mental health conditions, and physical illness) and nursing home measures (source of admission, length of stay, and mortality in the facility) of veterans who were homeless, at risk for being homeless, or stably housed in the year prior to admission.DesignCross-sectional analysis.Setting and participantsAll veterans admitted to a nursing home between January 2010 and December 2016 and their housing status in the year prior to their nursing home admission.MeasurementsAdjusted relative risks (ARRs) for the association between housing status, comorbidities, and nursing home measures.ResultsVeterans who were homeless in the year prior to their community nursing home admission were younger (n = 3355; 62.5 years [SD = 10.3 years]) at admission compared to stably housed veterans (n = 64 884; 75.3 years [SD = 11.9 years]). After adjustment for demographic characteristics, homeless veterans were more likely to have diagnoses for alcohol abuse (ARR = 2.18; 95% confidence interval [CI] = 2.05-2.31), drug abuse (ARR = 3.03; 95% CI = 2.74-3.33), mental health condition (ARR = 1.49; 95% CI = 1.45-1.54), dementia (ARR = 1.14; 95% CI = 1.04-1.25), liver disease (ARR = 1.32; 95% CI = 1.23-1.41), lung disease (ARR = 1.08; 95% CI = 1.04-1.13), and trimorbidity (co-occurring substance abuse, mental illness, and physical illness) (ARR = 2.57; 95% CI = 2.40-2.74) compared to stably housed veteran nursing home users. Homeless veterans were more likely to be admitted to a nursing home from a hospital (ARR = 1.13; 95% CI = 1.08-1.17) and remain in the nursing home 90 days after admission (ARR = 1.10; 95% CI = 1.04-1.16), but were less likely to die in the facility (ARR = 0.72; 95% CI = 0.67-0.78) compared to stably housed veterans.ConclusionsHomeless veteran nursing home users have different characteristics than stably housed veteran nursing home users. These differences may challenge nursing home staff caring for homeless patients. Nursing homes should assess resident housing status to help provide linkages with existing social services. J Am Geriatr Soc 67:1707-1712, 2019.

Project description:OBJECTIVE:This study aimed to further knowledge of older Veterans' experiences with transitioning to the community from Veterans Affairs nursing homes (Community Living Centers or CLCs) with emphasis on social functioning. DESIGN:A qualitative study design was used in addition to administration of standardized depression and mental status screens. SETTING AND PARTICIPANTS:Veterans (n = 18) and caregivers (n = 14) were purposively sampled and recruited from 2 rural CLCs in Upstate New York. METHODS:Semistructured interviews were completed with Veterans in the CLC prior to discharge (to explore experiences during the CLC stay and expectations regarding discharge and returning home) and in the home 2-4 weeks postdischarge (to explore daily routines and perceptions of overall health, mental health, and social functioning). Caregivers participated in 1 interview, completed postdischarge. The 9-item Patient Health Questionnaire and the Brief Interview for Mental Status were administered postdischarge. RESULTS:Thematic analysis of verbatim transcriptions revealed 3 inter-related themes: (1) Veterans may experience improved social connectedness in CLCs by nature of the unique care environment (predominantly male, shared military experience); (2) Experiences of social engagement and connectedness varied after discharge and could be discordant with Veterans' expectations for recovery prior to discharge; and (3) Veterans may or may not describe themselves as "lonely" after discharge, when physically isolated. Veterans lacked moderate to severe cognitive impairment (Brief Interview for Mental Status: range = 14-15); however, they reported a wide range in depressive symptom severity postdischarge (9-item Patient Health Questionnaire: mean = 4.9, SD = 6.1, median/mode = 3, range = 0-23). CONCLUSIONS AND IMPLICATIONS:This study identified a potential for increased social isolation and disengagement after discharge from Veterans Affairs nursing homes. Nursing homes should integrate social functioning assessment for their residents, while extending care planning and transitional care to address patient-centered social functioning goals.

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Dataset Information

Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams.

Background

Objective

Research design

Subjects

Measures

Results

Conclusions

Publications

Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams.

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