262951 Comparison of tailored and mainstream primary care delivery for homeless persons: A new, validated patient assessment

Wednesday, October 31, 2012

Erika Austin, PhD , C-SMART, Birmingham VA Medical Center, Birmingham, AL
Lori Davis, MD , TUA, Research & Development, Tuscaloosa VA Medical Center, Tuscaloosa, AL
Theresa Kim, MD , Boston University School of Medicine, Boston Medical Center, Boston, MA
Cheryl L. Holt, PhD , Department of Behavioral and Community Health; School of Public Health, University of Maryland, College Park, MD
David Pollio, PhD , School of Social Work, University of Alabama, Tuscaloosa, AL
Kay Johnson, RN , C-Smart, Birmingham VA Medical Center, Birmingham, AL
Jocelyn Steward, MPH , School of Public Health, University of Alabama at Birmingham, Birmingham, AL
Adam Gordon , Department of Veterans Affairs, VA Pittsburgh Healthcare System, Pittsburgh, PA
Erin Stringfellow, BA , Research, Boston Healthcare for the Homeless, Boston, MA
Joya Golden, MSW , MIRECC, VA Greater Los Angeles Healthcare System, Los Angeles, CA
Alexander Young, MD, MSHS , Psychiatry, UCLA & Greater Los Angeles VA, Los Angeles, CA
Stefan Kertesz, MD , C-SMART, Birmingham VA Medical Center, Birmingham, AL
Background: Many organizations tailor primary care services for homeless individuals, an initiative recently embraced by the Veterans Health Administration. This study compared homeless patients' assessments of tailored and non-tailored health care settings. Methods: Based on extensive qualitative research, we developed a Primary Care Quality Survey for the Homeless (PCQ-H) to assess patient experiences with 8 aspects of care identified by IoM reports and 3 additional gleaned from the qualitative research (respect, substance abuse/mental illness, homeless-specific needs). The survey was administered to 474 homeless individuals receiving care at a mainstream VA, moderately-tailored VA, highly-tailored VA, or a highly-tailored non-VA program. We compared PCQ-H scores across the sites, adjusting for relevant demographic and health characteristics. As ratings of care were primarily positive, we also compared a binary indicator of offering more than the median number of unfavorable or negative assessments of care across sites. Results: In analyses adjusted for case-mix, the highly-tailored non-VA program exceeded the VA sites for Patient-Clinician Relationship (p<.01), Perceived Cooperation (p<.01), and Homeless-Specific Needs (p<.05). Unfavorable responses were 10-25% more prevalent at the two VA sites compared to both highly-tailored sites (all p<.05). Conclusions: Homeless patients rate their relationship to their provider, cooperation among caregivers, and care for homeless-specific needs more highly when primary care services are highly-tailored. Whether such results generalize to diverse care settings remains to be seen. This new specialized patient assessment survey permits a rigorous examination of the extent to which service tailoring improves the primary care experience of this highly vulnerable population.

Learning Areas:
Conduct evaluation related to programs, research, and other areas of practice

Learning Objectives:
1. Learners will gain familiarity with a new instrument designed to enable homeless-experienced patients to rate their primary care 2. Learners will be able to articulate major differences between homeless-tailored and mainstream primary care service delivery, as rated by homeless patients.

Keywords: Homeless Health Care, Patient Satisfaction

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I have conducted research on health care access among vulnerable populations and served as a methodologist on numerous funded grants.
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.