Patient-aligned Care Team Engagement to Connect Veterans Experiencing Homelessness With Appropriate Health Care

• Published in: Medical care 2017-09, Vol.55 (9), p.S104-S110
• Main Authors: Gundlapalli, Adi V., Redd, Andrew, Bolton, Daniel, Vanneman, Megan E., Carter, Marjorie E., Johnson, Erin, Samore, Matthew H., Fargo, Jamison D., O’Toole, Thomas P.
• Format: Article
• Language: English
• Subjects: Delivery of Health Care - utilization; Emergency Service, Hospital - utilization; Female; Homeless Persons; Hospitals, Veterans; Humans; Male; Middle Aged; Original Research; Patient Care Team - organization & administration; Patient-Centered Care - organization & administration; United States; Veterans - psychology
• ISSN: 0025-7079; 1537-1948
• DOI: 10.1097/MLR.0000000000000770

BACKGROUND:Veterans experiencing homelessness frequently use emergency and urgent care (ED). OBJECTIVE:To examine the effect of a Patient-aligned Care Team (PACT) model tailored to the unique needs of Veterans experiencing homelessness (H-PACT) on frequency and type of ED visits in Veterans Health Administration (VHA) medical facilities. RESEARCH DESIGN:During a 12-month period, ED visits for 3981 homeless Veterans enrolled in (1) H-PACT at 20 VHA medical centers (enrolled) were compared with those of (2) 24,363 homeless Veterans not enrolled in H-PACT at the same sites (nonenrolled), and (3) 23,542 homeless Veterans at 12 non-H-PACT sites (usual care) using a difference-in-differences approach. MEASURE(S):The primary outcome was ED and other health care utilization and the secondary outcome was emergent (not preventable/avoidable) ED visits. RESULTS:H-PACT enrollees were predominantly white males with a higher baseline Charlson comorbidity index. In comparing H-PACT enrollees with usual care, there was a significant decrease in ED usage among the highest ED utilizers (difference-in-differences, −4.43; P