Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams

Abstract

Background: In 2012, select Veterans Health Administration (VHA) facilities implemented a homeless-tailored medical home model, called Homeless Patient Aligned Care Teams (H-PACT), to improve care processes and outcomes for homeless Veterans.

Objective: The main aim of this study was to determine whether H-PACT offers a better patient experience than standard VHA primary care.

Research design: We used multivariable logistic regressions to estimate differences in the probability of reporting positive primary care experiences on a national survey.

Subjects: Homeless-experienced survey respondents enrolled in H-PACT (n=251) or standard primary care in facilities with H-PACT available (n=1527) and facilities without H-PACT (n=10,079).

Measures: Patient experiences in 8 domains from the Consumer Assessment of Healthcare Provider and Systems surveys. Domain scores were categorized as positive versus nonpositive.

Results: H-PACT patients were less likely than standard primary care patients to be female, have 4-year college degrees, or to have served in recent military conflicts; they received more primary care visits and social services. H-PACT patients were more likely than standard primary care patients in the same facilities to report positive experiences with access [adjusted risk difference (RD)=17.4], communication (RD=13.9), office staff (RD=13.1), provider ratings (RD=11.0), and comprehensiveness (RD=9.3). Standard primary care patients in facilities with H-PACT available were more likely than those from facilities without H-PACT to report positive experiences with communication (RD=4.7) and self-management support (RD=4.6).

Conclusions: Patient-centered medical homes designed to address the social determinants of health offer a better care experience for homeless patients, when compared with standard primary care approaches. The lessons learned from H-PACT can be applied throughout VHA and to other health care settings.

Figure.

Inclusion and exclusion criteria applied to create an analytic sample of homeless patients who received care at Veterans Healthcare Administration (VHA) facilities with or without an Homeless Patient Aligned Care Team (H-PACT) among their services, and who completed the 2014-2015 Patient Centered Medical Home Survey of Healthcare Experiences of Patients (PCMH-SHEP). Exclusion criteria were applied sequentially.