Study Suggests Benefits of Medical Home Model Tailored for Homeless Veterans Versus Standard Primary Care

BACKGROUND:
In 2012, select VA facilities implemented a homeless-tailored medical home model (H-PACT) to enhance access to care, address the social determinants of health, and facilitate housing placement for Veterans who are homeless or at risk for homelessness. This study examined whether H-PACT offers a better patient experience than standard VA primary care. Participants included homeless experienced Veterans enrolled in H-PACT (n=251) or standard primary care in facilities with H-PACT among their services (n=1,527) and in VA facilities without any H-PACT (n=10,079). Investigators examined positive patient experiences, as reported in VA's 2014-2015 mailed Survey of Healthcare Experiences of Patients (SHEP), in eight domains: access, communication, office staff, comprehensiveness, shared decision-making, self-management support, care coordination, and rating of providers.

FINDINGS:

• Veterans empaneled in H-PACT were more likely than those receiving standard primary care in the same facilities to report positive experiences with access, communication, office staff, provider ratings, and comprehensiveness.
• Veterans receiving standard care in facilities with H-PACT among their services were more likely than Veterans from facilities without H-PACT to report positive experiences with communication and self-management support.

IMPLICATIONS:

• Patient-centered medical homes that are designed to address the social determinants of health offer a better care experience for homeless Veterans than standard primary care approaches.
• The lessons learned from H-PACT can be scaled throughout VA and form the basis for caring for vulnerable patients in other healthcare settings.

LIMITATIONS:

• Study estimates of positive care experiences could be optimistic if survey response was lower in Veterans with current (as opposed to prior) homelessness, and if current homelessness was associated with worse primary care experience reporting.
• The study measure of patient experience did not assess homeless-specific concerns and service needs, i.e., stigma related to homelessness and assistance in obtaining food, shelter, or clothing.

AUTHOR/FUNDING INFORMATION:
This research was supported in part by the VA National Center on Homelessness Among Veterans and HSR&D (IIR 15-095 and IIR 12-084). Authors Jones, Gordon, Gundlapalli, Pettey, and Suo are part of HSR&D's Informatics, Decision-Enhancement and Analytic Sciences Center, Salt Lake City, UT. Drs. Hausmann, Cashy, and Mor are part of HSR&D's Center for Health Equity Research & Promotion in Pittsburgh and Philadelphia. Dr. Kertesz is with the Birmingham VA Medical Center.

Jones A, Hausmann L, Kertesz S, Suo Y, Cashy J, Mor M, Pettey W, Schaefer J, Gordon A and Gundlapalli A. Providing Positive Primary Care Experiences for Homeless Veterans through Tailored Medical Homes: The Veterans Health Administration’s Homeless Patient Aligned Care Teams. Medical Care. April 2019;57(4):270-78.