New to Care

Demands on a Health System When Homeless Veterans Are Enrolled in a Medical Home Model

Dados Bibliográficos

ID11026258
AutoresThomas O’toole (0000-0001-9830-4229, Providence VA Medical Center), Thomas P O’Toole (Thomas P. O’Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.), Claire Bourgault (Thomas P. O’Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.), Erin Johnson (0000-0003-1150-1823, Providence VA Medical Center), Erin E Johnson (0000-0002-5160-8775, Thomas P. O’Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.), Stephen G Redihan (Thomas P. O’Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.), Matthew Borgia (Thomas P. O’Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.), Riccardo Aiello (Thomas P. O’Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.), Vincent Kane (Thomas P. O’Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.)
Ano2013
Volume103
FascículoS2
PáginasS374-S379
Data de publicação2013-12-01
Peer ReviewedSim
Open AccessNão
TipoARTICLE
PeriódicoAmerican Journal of Public Health (JOURNAL)
Identificadores do periódicoISSN: 0090-0036 • E-ISSN: 1541-0048
EditoraAmerican Public Health Association (PUBLISHER • US)
DOI10.2105/ajph.2013.301632
PMID24148042
PMCIDPMC3969111
OpenAlexW2165259396
IdiomaEN
Citações recebidas10
Referências citadas18

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

Confidence interval · Emergency department · Family medicine · Health care · Medical home · Mental health · Primary care · Psychiatry · Relative risk · Specialty · Substance abuse · Veterans Affairs · Food Security and Health in Diverse Populations · Geriatric Care and Nursing Homes · Homelessness and Social Issues · Medicine · Gerontology