262784 "Medical Home Without Walls:" An Innovative Health Care Delivery Model for Poor and Homeless Populations

Monday, October 29, 2012 : 9:10 AM - 9:30 AM

Roseanna H. Means, MD MSc , Department of Medicine, Brigham and Women's Hospital, Wellesley, MA
Kym Williams, MBA, MPH , Monitoring and Evaluation, Women of Means, Inc., Wellesley, MA
Lauren Owens, MD , Department of Maternal and Child Health, University of Minnesota School of Public Health, Minneapolis, MN
Megan Bratton, BS , Boston University School of Public Health, Boston
Background: Homeless and vulnerable populations face barriers in accessing mainstream medical care. The multi-dimensional aspect of their health issues compounds the challenges of navigating a complex and decentralized health care system. Services that provide barrier-free, context-specific care have the potential to improve health outcomes and better serve the needs of at-risk populations. To determine the impact of community-specific health care, we evaluated a “medical home without walls” intervention program located in two women's day shelters in Boston. Study Objective: Describe an effective health care intervention model for poor and homeless women in Boston utilizing longitudinal care given by volunteer clinical teams integrated into day shelter services. Methods: Patient survey (N=102) and non-participant observations (N=72) administered June to December 2011 in two women's day shelters in Boston. Documented patient engagement and assessment processes, service attributes, predisposing risk factors, patient characteristics and needs, impact and outcomes. Data analysis was conducted using frequency tables, proportion analysis and thematic coding using NVivo9 to identify factors associated with interventions. Preliminary Results: Patient risk profiles range from at-risk to affected; engagement pathways dictate the level of service; contextual factors associate with patient needs, encounter times and service type. Results indicate a context-specific, low stress, multi-service model positively affects individual, community and system outcomes. Conclusions: This study offers a systematic understanding of the pathways through which poor and homeless women can access the health care system through community-based, context-specific health care services and provides support for expanding this “medical home without walls” model for other at-risk populations.

Learning Areas:
Implementation of health education strategies, interventions and programs
Provision of health care to the public
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
1. Demonstrate a novel approach to delivering health care services to poor and homeless populations. 2. Describe the potential of a “medical home without walls” model to bridge the gap between mainstream medical care and at-risk populations. 3. Discuss practical application of the “medical home without walls” model and opportunities under the Patient Protection and Affordable Care Act (ACA).

Keywords: Homeless Health Care, Models for Provision

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a recognized authority on health care for displaced persons. I have served as Program Medical Director for Healthcare for the Homeless Program, Medical Director for the Barbara McInnis House respite care facility for homeless persons, and since 1999 founder and Chief Medical Officer of Women of Means, a free shelter-based health care program. I am Associate Clinical Professor of Medicine at Harvard Medical School and Attending Staff Physician at Brigham and Women's Hospital.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.