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Primary Care Continuity and Utilization Patterns for Veterans With Homeless Experience.

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Veterans with homeless experience (VHE) in specialized H-PACT clinics showed improved primary care continuity compared to those in mainstream PACTs. This enhanced continuity did not lead to increased specialty or emergency care utilization.

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Area of Science:

  • Health Services Research
  • Veterans Health
  • Primary Care Models

Background:

  • Continuity of care is crucial for high-quality primary care, yet vulnerable populations often face fragmented care.
  • The US Department of Veterans Affairs (VA) offers specialized Patient Aligned Care Teams (PACTS) called H-PACTs for veterans with homeless experience (VHE).

Purpose of the Study:

  • To evaluate if VHEs in H-PACTs experience higher primary care continuity than those in mainstream VA PACTs.
  • To compare other service utilization patterns between VHEs in H-PACTs and mainstream PACTs.

Main Methods:

  • A retrospective observational cohort study utilized national survey and VA electronic health records data.
  • Included VHEs with at least two primary care visits in the 12 months preceding a 2018 national survey.
  • Continuity was measured by the usual provider of care (UPC) proportion; multivariable regression analyzed associations.

Main Results:

  • VHEs in H-PACTs demonstrated higher mean UPC (0.81 vs. 0.77) and greater likelihood of high continuity (65.3% vs. 57.7%) compared to mainstream PACTs.
  • After adjustment, H-PACT enrollment remained associated with high continuity (OR, 1.48).
  • H-PACT enrollees had more primary care visits, fewer specialty visits, and reduced emergency department (ED) visits.

Conclusions:

  • VHEs in H-PACT clinics experienced superior primary care continuity.
  • The H-PACT model appears associated with less intensive healthcare delivery without substituting specialty or emergency care.
  • This suggests H-PACTs are an effective model for improving care continuity for VHEs.