Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program

Details

• Journal Article:
  Preventing Chronic Disease (PCD)
• Personal Author:
  O’Toole, Thomas P. ; Johnson, Erin E. ; Aiello, Riccardo ; Kane, Vincent ; Pape, Lisa
• Description:
  Introduction
  
  Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. We described the national implementation of a “homeless medical home” initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites.
  
  Methods
  
  We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team (H-PACT) program implementation. We defined high performance as high rates of ambulatory care and reduced use of acute care services.
  
  Results
  
  More than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies.
  
  Conclusion
  
  Integrating social determinants of health into clinical care can be effective for high-risk homeless veterans.
  
  
• Subjects:
  Aged Ambulatory Care Emergency Service, Hospital Female Hospitalization Humans Ill-Housed Persons Male Middle Aged Patient-Centered Care Social Determinants Of Health Veterans Veterans Health Vulnerable Populations

  More +
• Source:
  Prev Chronic Dis. 13.
• DOI:
  http://dx.doi.org/10.5888/pcd13.150567
• ISSN:
  1545-1151
• Pubmed ID:
  27032987
• Pubmed Central ID:
  PMC4825747
• Document Type:
  Journal Article
• Name as Subject:
  United States. Department of Veterans Affairs. ; United States. Department of Veterans Affairs.
• Place as Subject:
  United States
• Location:
  North America
• Volume:
  13
• Collection(s):
  Preventing Chronic Disease
• Main Document Checksum:
  urn:sha-512:0a33f443f562230f37f07b471148eaf75976e501f1446ed4109d22f2bca65785ba94bf9acbf86e9f5608504aabb53cbec7f272eee6caed7a81edc7dcb4aadc1a
• Download URL:
  https://stacks.cdc.gov/view/cdc/39471/cdc_39471_DS1.pdf
• File Type:
  [PDF - 381.41 KB ]