Population-Tailored Care for Homeless Veterans and Acute Care Use, Cost, and Satisfaction: A Prospective Quasi-Experimental Trial

Details

• Journal Article:
  Preventing Chronic Disease (PCD)
• Personal Author:
  O’Toole, Thomas P. ; Johnson, Erin E. ; Borgia, Matthew ; Noack, Amy ; Yoon, Jean ; Gehlert, Elizabeth ; Lo, Jeanie
• Description:
  Introduction ; Although traditional patient-centered medical homes (PCMHs) are effective for patients with complex needs, it is unclear whether homeless-tailored PCMHs work better for homeless veterans. We examined the impact of enrollment in a Veterans Health Administration (VHA) homeless-tailored PCMH on health services use, cost, and satisfaction compared with enrollment in a traditional, nontailored PCMH. ; Methods ; We conducted a prospective, multicenter, quasi-experimental, single-blinded study at 2 VHA medical centers to assess health services use, cost, and satisfaction during 12 months among 2 groups of homeless veterans: 1) veterans receiving VHA homeless-tailored primary care (Homeless-Patient Aligned Care Team H-PACT) and 2) veterans receiving traditional primary care services (PACT). A cohort of 266 homeless veterans enrolled from June 2012 through January 2014. ; Results ; Compared with PACT patients, H-PACT patients had more social work visits (4.6 vs 2.7 visits) and fewer emergency department (ED) visits for ambulatory care-sensitive conditions (0 vs 0.2 visits); a significantly smaller percentage of veterans in H-PACT were hospitalized (23.1% vs 35.4%) or had mental health–related ED visits (34.1% vs 47.6%). We found significant differences in primary care provider–specific visits (H-PACT, 5.1 vs PACT, 3.6 visits), mental health care visits (H-PACT, 8.8 vs PACT, 13.4 visits), 30-day prescription drug fills (H-PACT, 40.5 vs PACT, 58.8 fills), and use of group therapy (H-PACT, 40.1% vs PACT, 53.7%). Annual costs per patient were significantly higher in the PACT group than the H-PACT group ($37,415 vs $28,036). In logistic regression model of acute care use, assignment to the H-PACT model was protective as was rating health “good” or better. ; Conclusion ; Homeless veterans enrolled in the population-tailored primary care approach used less acute care and costs were lower. Tailored-care models have implications for care coordination in the US Department of Veterans Affairs VA and community health systems.
• Subjects:
  • Adult
  • Chronic Disease
  • Critical Care
  • Female
  • Ill-Housed Persons
  • Humans
  • Male
  • Middle Aged
  • Non-Randomized Controlled Trials as Topic
  • Patient Satisfaction
  More +
• Source:
  Prev Chronic Dis. 15.
• DOI:
  http://dx.doi.org/10.5888/pcd15.170311
• ISSN:
  1545-1151
• Pubmed ID:
  29451116
• Pubmed Central ID:
  PMC5814153
• Document Type:
  Journal Article
• Corporate as Subject:
  United States' Department of Veterans Affairs' ; United States' Department of Veterans Affairs'
• Place as Subject:
  United States
• Location:
  North America
• Volume:
  15
• Download URL:
  https://stacks.cdc.gov/view/cdc/52345/cdc_52345_DS1.pdf
• File Type:
  [PDF - 387.91 KB]
• Collection(s):
  Preventing Chronic Disease
• Main Document Checksum:
  urn:sha-512:e479788c39cb53f9ba6ba8cc058f2a996634f085217d3c053bfbad642244f5c494003018cee8fbf40eccd5b7a797e1942a2affac4e6f30937d44ea5323ce76db