Online Program

284320
An evening primary care clinic for homeless veterans: A social determinants approach to intensive care management for complex, vulnerable, high-utilizer patients


Tuesday, November 5, 2013 : 2:50 p.m. - 3:10 p.m.

Rishi Manchanda, MD MPH, Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, CA
Beena Patel, MPH, UCLA School of Public Health, VA Greater Los Angeles, Los Angeles, CA
Jennifer Chen, MD, MPH, Emergency Department and Internal Medicine, VA Greater Los Angeles, Los Angeles, CA
Lillian Gelberg, MD, MSPH, Family Medicine, University of California, Los Angeles, Los Angeles, CA
Lisa Altman, MD, Office of Healthcare Transformation and Innovation, VA Greater Los Angeles Healthcare System, Los Angeles, CA
In the US Department of Veterans Affairs (VA), a patient-centered medical home model known as the Patient Aligned Care Team (PACT) and related population-oriented primary care approaches have been advocated to improve healthcare coordination, particularly for vulnerable, homeless Veterans. Meanwhile, recent expansion of a VA Housing-First model shows promise in housing homeless Veterans. In practice, integration of these healthcare and housing models is poorly understood. In a VA-funded demonstration project in Los Angeles, we adapted Social Determinants of Health, Community Oriented Primary Care (COPC) and Ambulatory Intensive Caring Unit (AICU) approaches to establish a clinic for homeless Veterans with complex social and medical needs and high utilization of emergency and inpatient services. Preliminary results show 7 month reductions in emergency department utilization (36%) and hospitalizations (33%). We also observed improvements in 'vertical' and 'horizontal' integration among health, housing and social service sectors. This approach represents a model for coordinated, intersectoral action to improve health and social determinants for high-utilizer homeless adults and other complex, vulnerable patients. To our knowledge, this is the first approach to describe the application of the World Health Organization's Conceptual Framework for Social Determinants of Health Interventions in the design of homeless healthcare delivery and one of the first applications of the AICU model to care for high-risk homeless adults.

Learning Areas:

Chronic disease management and prevention
Clinical medicine applied in public health
Implementation of health education strategies, interventions and programs
Planning 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:
List at least three large-scale initiatives of the Department of Veterans Affairs that seek to improve healthcare and housing for homeless Veterans Define at least three defining components in each of three frameworks as they relate to homeless adults: the WHO Social Determinants of Health Framework for Intervention, Community-Oriented Primary Care, and Ambulatory Intensive Caring Unit Describe an evidence-based practical approach to align healthcare and housing sectors to provide care and address social determinants for complex, high-risk and high-utilizing homeless adults List at least two preliminary findings associated with a new primary care clinic that applied a social determinants approach for intensive care management for homeless adults at the VA Greater Los Angeles Healthcare system.

Keyword(s): Homeless Health Care, Community-Oriented Primary Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the lead physician of the Homeless Patient Aligned Care Team at the VA Greater Los Angeles Healthcare System and helped build a new clinic for complex, high-utilizing homeless Veterans. I was formerly the founding Director of Social Medicine at a community health center network in South LA. I am the founder of a public health enterprise, called HealthBegins, that provides expertise and tools to help improve healthcare and the social determinants of health.
Any relevant financial relationships? Yes

Name of Organization Clinical/Research Area Type of relationship
HealthBegins social determinants of health, healthcare delivery I am the founder of a public health enterprise, called HealthBegins, that provides expertise and tools to help improve healthcare and the social determinants of health.

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.