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

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.