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Comparing homeless persons' care experiences in tailored versus nontailored primary care programs
Stefan G Kertesz1, Cheryl L Holt, Jocelyn L Steward
1Stefan G. Kertesz, Erika L. Austin, N. Kay Johnson, and U. Shanette Granstaff are with the Birmingham VA Medical Center, Birmingham, AL. Cheryl L. Holt is with the University of Maryland, Baltimore. Jocelyn L. Steward is with the University of Alabama, Birmingham. Richard N. Jones is with Brown University, Providence, RI. David L. Roth is with Johns Hopkins University, Baltimore, MD. Erin Stringfellow is with Washington University, St. Louis, MO. Adam J. Gordon is with the VA Pittsburgh Healthcare System, Pittsburgh, PA. Theresa W. Kim is with the Boston Medical Center and the Boston Healthcare for the Homeless Program, Boston, MA. Stephen Randal Henry, Joya F. Golden, and Alexander S. Young are with the VA Medical Center, Greater Los Angeles, Los Angeles, CA. James J. O'Connell is with the Boston Health Care for the Homeless Program, Boston. Lori L. Davis is with the Tuscaloosa VA Medical Center, Tuscaloosa, AL. David E. Pollio is with the University of Alabama, Tuscaloosa.
Objectives:
We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring.
Methods:
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.
Results:
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.
Conclusions:
Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.
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