Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration’s “Homeless Patient Aligned Care Team” Program
Open Access
- 31 March 2016
- journal article
- research article
- Published by Centers for Disease Control and Prevention (CDC) in Preventing Chronic Disease
- Vol. 13, E44
- https://doi.org/10.5888/pcd13.150567
Abstract
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. 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. 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. Integrating social determinants of health into clinical care can be effective for high-risk homeless veterans.Keywords
This publication has 25 references indexed in Scilit:
- A cross-sectional observational study of unmet health needs among homeless and vulnerably housed adults in three Canadian citiesBMC Public Health, 2013
- Mortality Among Homeless Adults in BostonJAMA Internal Medicine, 2013
- Emergency department visits in Veterans Affairs medical facilities.2011
- The Unmet Health Care Needs of Homeless Adults: A National StudyAmerican Journal of Public Health, 2010
- Health care of homeless veteransJournal of General Internal Medicine, 2003
- Emergency Department Use Among the Homeless and Marginally Housed: Results From a Community-Based StudyAmerican Journal of Public Health, 2002
- Factors associated with the health care utilization of homeless persons.JAMA, 2001
- Hospitalization Costs Associated with Homelessness in New York CityThe New England Journal of Medicine, 1998
- Causes of Death in Homeless Adults in BostonAnnals of Internal Medicine, 1997
- Mortality in a Cohort of Homeless Adults in PhiladelphiaThe New England Journal of Medicine, 1994