Informatics, Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center, Veterans Affairs Salt Lake City Health Care System.
Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, UT.
Med Care. 2018 Jul;56(7):610-618. doi: 10.1097/MLR.0000000000000926.
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.
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).
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.
Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941).
Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support.
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).
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.
无家可归的患者描述了他们在初级保健方面的糟糕体验。2012 年，退伍军人健康管理局（Veterans Health Administration，VHA）实施了针对无家可归者的量身定制的初级保健团队（Homeless Patient Aligned Care Team，HPACT），这可能会改善无家可归患者的初级保健体验。
评估在有 HPACT 的退伍军人健康管理局（Veterans Health Administration，VHA）设施（HPACT 设施）和没有 HPACT 的退伍军人健康管理局（Veterans Health Administration，VHA）设施（非 HPACT 设施）中接受护理的无家可归和非无家可归退伍军人在初级保健体验方面的差异。
我们使用多变量多项回归来估计在全国 VHA 调查中报告的初级保健体验（分为负面/中等/积极）方面的无家可归与非无家可归患者之间的差异。我们比较了在 25 个 HPACT 设施和 485 个非 HPACT 设施中，报告负面或积极体验的无家可归与非无家可归患者的风险差异（RD）。
非 HPACT 设施（无家可归者：n=10148；非无家可归者：n=309779）和 HPACT 设施（无家可归者：n=2022；非无家可归者：n=20941）的调查受访者。
获得医疗服务、沟通、办公室工作人员、提供者评级、全面性、协调性、共同决策、自我管理支持方面的负面和积极体验。
在非 HPACT 设施中，无家可归患者报告的负面体验比非无家可归患者多，而积极体验比非无家可归患者少。然而，在 HPACT 设施中，这些无家可归与非无家可归患者之间差异的模式发生了逆转，在沟通（非 HPACT 与 HPACT 设施的积极体验 RD 分别为-2.0 和 2.0）、全面性（负面 RD=2.1 和-2.3）、共同决策（负面 RD=1.2 和-1.8）和自我管理支持（负面 RD=0.1 和-4.5；积极 RD=0.5 和 8.0）方面。
VHA 设施的 HPACT 项目似乎为无家可归和非无家可归的退伍军人提供了更好的初级保健体验，改变了通常与无家可归相关的相对较差的初级保健体验模式。
