New to care: Demands on a health system when homeless veterans are enrolled in a medical home model

T.P. O'Toole, C. Bourgault, E.E. Johnson, S.G. Redihan, M. Borgia, R. Aiello and V. Kane

American Journal of Public Health, 2013, vol. 103, issue S2, S374-S379

Abstract: Objectives. We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use. Methods. We used case-control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011. Results. We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage. Conclusions. Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use.

Keywords: adult; article; chronic disease; emergency health service; female; government; health service; health status; homelessness; human; male; mental health; middle aged; organization and management; patient care; primary health care; statistics; United States; utilization review; veteran; health service; homelessness; organization and management; patient care; statistics and numerical data; utilization; veteran, Adult; Chronic Disease; Emergency Service, Hospital; Female; Health Services; Health Status; Homeless Persons; Humans; Male; Mental Health; Middle Aged; Patient-Centered Care; Primary Health Care; Rhode Island; United States; United States Department of Veterans Affairs; Veterans, Adult; Chronic Disease; Emergency Service, Hospital; Female; Health Services; Health Status; Homeless Persons; Humans; Male; Mental Health; Middle Aged; Patient-Centered Care; Primary Health Care; Rhode Island; United States; United States Department of Veterans Affairs; Veterans (search for similar items in EconPapers)
Date: 2013
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Persistent link: https://EconPapers.repec.org/RePEc:aph:ajpbhl:10.2105/ajph.2013.301632_6

DOI: 10.2105/AJPH.2013.301632

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