Audrey L Jones1,2, Leslie R M Hausmann3,4, Stefan Kertesz5,6, Ying Suo1,2, John P Cashy3, Maria K Mor3,7, James H Schaefer8, Adi V Gundlapalli1,2, Adam J Gordon1,2,9. 1. Informatics, Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center, Veterans Affairs Salt Lake City Health Care System. 2. Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT. 3. Center for Health Equity Research and Promotion, Veterans Affairs Pittsburgh Healthcare System. 4. Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, PA. 5. Birmingham VA Medical Center. 6. Department of Medicine, University of Alabama at Birmingham School of Medicine, Birmingham, AL. 7. Department of Biostatistics, University of Pittsburgh Graduate School of Public Health, Pittsburgh, PA. 8. Department of Veterans Affairs Office of Reporting, Analytics, Performance, Improvement and Deployment, Durham, NC. 9. Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, UT.
Abstract
BACKGROUND: Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. OBJECTIVE: To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). RESEARCH DESIGN: We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. SUBJECTS: Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). MEASURES: Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. RESULTS: In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). CONCLUSIONS: VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.
BACKGROUND: Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients. OBJECTIVE: To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities). RESEARCH DESIGN: We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities. SUBJECTS: Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941). MEASURES: Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support. RESULTS: In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0). CONCLUSIONS: VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.
Authors: Audrey L Jones; Leslie R M Hausmann; Stefan G Kertesz; Ying Suo; John P Cashy; Maria K Mor; Warren B P Pettey; James H Schaefer; Adam J Gordon; Adi V Gundlapalli Journal: Med Care Date: 2019-04 Impact factor: 2.983
Authors: Nodira Codell; A Taylor Kelley; Audrey L Jones; Matthew T Dungan; Natalie Valentino; Ana I Holtey; Tania J Knight; Amy Butz; Christina Gallop; Sean Erickson; Jeremy Patton; Laura Jane Hyte-Richins; Benjamin Z Rollins; Adam J Gordon Journal: Am J Drug Alcohol Abuse Date: 2020-12-10 Impact factor: 3.829
Authors: Audrey L Jones; Adam J Gordon; Sonya E Gabrielian; Ann Elizabeth Montgomery; John R Blosnich; Allyson L Varley; Aerin J deRussy; Erika L Austin; April E Hoge; Young-Il Kim; Lillian Gelberg; Stefan G Kertesz Journal: Med Care Date: 2021-06-01 Impact factor: 3.178
Authors: Sonya Gabrielian; Audrey L Jones; April E Hoge; Aerin J deRussy; Young-Il Kim; Ann Elizabeth Montgomery; John R Blosnich; Adam J Gordon; Lillian Gelberg; Erika L Austin; David Pollio; Sally K Holmes; Allyson L Varley; Stefan G Kertesz Journal: J Prim Care Community Health Date: 2021 Jan-Dec
Authors: Allyson L Varley; Ann Elizabeth Montgomery; Jocelyn Steward; Erin Stringfellow; Erika L Austin; Adam J Gordon; David Pollio; Aerin deRussy; April Hoge; Lillian Gelberg; Kevin Riggs; Theresa W Kim; Sonia L Rubens; Stefan G Kertesz Journal: Qual Health Res Date: 2020-01-02