Comparing Homeless Persons' Care Experiences in Tailored Versus Nontailored Primary Care Programs

• Published in: American journal of public health (1971) Vol. 103; no. S2; pp. S331 - S339
• Main Authors: KERTESZ, Stefan G, HOLT, Cheryl L, JOHNSON, N. Kay, GRANSTAFF, U. Shanette, O'CONNELL, James J, GOLDEN, Joya F, YOUNG, Alexander S, DAVIS, Lori L, POLLIO, David E, STEWARD, Jocelyn L, JONES, Richard N, ROTH, David L, STRINGFELLOW, Erin, GORDON, Adam J, KIM, Theresa W, AUSTIN, Erika L, HENRY, Stephen Randal
• Format: Journal Article
• Language: English
• Published: Washington, DC American Public Health Association 01.12.2013
• Subjects: Adult; Biological and medical sciences; Cooperation; Design; Female; General aspects; Health care access; Health care policy; Health facilities; Health Service Delivery; Health Services Accessibility - organization & administration; Health Status; Homeless people; Homeless Persons - statistics & numerical data; Homelessness; Hospitals; Humans; Hypotheses; Indigent care; Male; Medical sciences; Mental health; Mental Health Services - organization & administration; Middle Aged; Miscellaneous; Mortality; Patient Protection & Affordable Care Act 2010-US; Patient Satisfaction; Patients; Primary care; Primary Health Care - organization & administration; Public health; Public health. Hygiene; Public health. Hygiene-occupational medicine; Qualitative research; Quality Of Care; Quality of Health Care - organization & administration; Research and Practice; Socioeconomic Factors; Studies; Surveys; United States; United States Department of Veterans Affairs - organization & administration; Urban Health; United States; United States > US; Patient-centered approach; Homeless; Primary health care; Comparative study; Public health; Care
• ISSN: 0090-0036; 1541-0048
• DOI: 10.2105/AJPH.2013.301481

We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring. We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients. Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient-clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient-clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results. Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.