142nd APHA Annual Meeting and Exposition

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Comparison of patient experience between a practice for the homeless and other practices engaged in a patient-centered medical home initiative

142nd APHA Annual Meeting and Exposition (November 15 - November 19, 2014): http://www.apha.org/events-and-meetings/annual
Tuesday, November 18, 2014 : 10:50 AM - 11:10 AM

Bittie Behl-Chadha, Ph.D. , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Michael Gagnon , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Pei-Pei Lei, M.A. , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Monica Bharel, MD, MPH , Boston Health Care for the Homeless Program, Boston, MA
Carla Hillerns, M.P.A, M.U.P. , Center for Health Policy and Research, University of Massachusetts Medical School, Shrewsbury, MA
Judith Savageau, MPH , Family Medicine and Community Health, University of Massachusetts Medical School, Worcester, MA
Ann Lawthers, Ph.D.
Background: The patient-centered medical home (PCMH) care model has been gaining popularity but little is known about its implementation in clinical settings serving homeless populations. The Massachusetts PCMH initiative, launched in 2011, is a 3-year demonstration project with 46 participating practices, including Boston Health Care for the Homeless Program (BHCHP). Key components assessing practice attainment of patient-centeredness include patient experience surveys (PES). BHCHP PES results were compared to non-homeless practice settings to describe perceptions of medical home principles’ adoption amongst the homeless.  

Methods: 34 non-rural practices were selected for comparison using adult PES data collected during the demonstration project’s Year 2. Variables examined included six Consumer Assessment of Healthcare Providers and Systems (CAHPS) measures linked to PCMH core competencies, adjusted for age, health status and education.

Results: Data from 164 BHCHP and 1,909 comparison practice patients were analyzed. Homeless patients were significantly younger (26% over 55 years vs 40%), male (67% vs 40%) and had no high school education (32% vs 26%). Homeless patients reported higher levels of self-management support (Mean=81.2 vs. 58.8) and mental health care (Mean=81.3 vs. 62.4). There were no differences in overall provider and health care access. However, BHCH patients reported lower ratings on provider-patient communication (Mean=84.5 vs. 88.4) and respectful staff (Mean=76.2 vs. 82.9).

Conclusions: In this era of health care reform, the medical home model for the homeless can not only achieve parity but can also exceed on delivering patient-centered care. PES can help identify areas for improvement for PCMH staff ensuring on-going care improvement.

Learning Areas:

Public health or related research

Learning Objectives:
Describe the similarities and differences in patient experience between a homeless and comparable non-homeless practice settings. Identify potential areas for focus/improvement in clinical settings serving the homeless as they strive to become patient-centered medical homes.

Keyword(s): Homelessness, Patient-Centered Care

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am the Director of the Office of Survey Research, which has conducted all the research associated with this project (Massachusetts Patient Centered Medical Home Initiative). I oversee the data collection and analysis for the study that is reported here and have insight into the issues being discussed around patient experience in a practice for the homeless compared to other practices.
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.

Back to: 4113.0: Services Through the Eyes of Individuals Who Are Homeless