Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: The Veterans Health Administration's "Homeless Patient Aligned Care Team" Program
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.
Below: Homeless-patient aligned care team model for treatment engagement
- 1National Center on Homelessness Among Veterans, Providence VA Medical Center, 830 Chalkstone Ave, Providence, RI 02909. Email: Thomas.OToole@va.gov.
- 2The National Center on Homelessness Among Veterans, Office of Homeless Programs, US Department of Veterans Affairs, Providence, Rhode Island.
- 3The National Center on Homelessness Among Veterans, Office of Homeless Programs, US Department of Veterans Affairs, Providence, Rhode Island and Lebanon VA Medical Center, Lebanon, Pennsylvania.
- Prev Chronic Dis. 2016 Mar 31;13:E44. doi: 10.5888/pcd13.150567.
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