Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams
Differences in Experiences With Care Between Homeless and Nonhomeless Patients in Veterans Affairs Facilities With Tailored and Nontailored Primary Care Teams
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DOI：
10.1097/mlr.0000000000000926
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发表时间：
2018-07-01
期刊：
影响因子：
3
通讯作者：
Gordon, Adam J.
中科院分区：
文献类型：
--
作者：
Jones, Audrey L.;Hausmann, Leslie R. M.;Gordon, Adam J.
背景：无家可归的患者描述了在初级医疗保健方面的不良体验。2012年，退伍军人健康管理局（VHA）组建了针对无家可归者的初级医疗保健团队（无家可归患者整合医疗团队，HPACTs），这可能会改善无家可归患者的初级医疗保健体验。
目的：评估在有HPACTs的VHA机构（HPACT机构）和没有HPACTs的VHA机构（非HPACT机构）中，无家可归和非无家可归的退伍军人在初级医疗保健体验上的差异。
研究设计：我们使用多变量多项回归来估计在一项全国性VHA调查中所报告的初级医疗保健体验（分为负面/中等/正面）方面无家可归患者与非无家可归患者的差异。我们比较了在25个HPACT机构和485个非HPACT机构中，无家可归者与非无家可归者在报告负面或正面体验方面的风险差异（RDs）。
研究对象：来自非HPACT机构（无家可归者：n = 10148；非无家可归者：n = 309779）和HPACT机构（无家可归者：n = 2022；非无家可归者：n = 20941）的调查受访者。
衡量指标：在获取医疗服务、沟通、办公室工作人员、医疗服务提供者评级、全面性、协调性、共同决策以及自我管理支持方面的负面和正面体验。
结果：在非HPACT机构中，无家可归患者比非无家可归患者报告了更多的负面体验和更少的正面体验。然而，在HPACT机构中，对于沟通领域（非HPACT机构与HPACT机构的正面体验RDs分别为 -2.0和2.0）、全面性（负面RDs分别为2.1和 -2.3）、共同决策（负面RDs分别为1.2和 -1.8）以及自我管理支持（负面RDs分别为0.1和 -4.5；正面RDs分别为0.5和8.0），无家可归者与非无家可归者差异的这些模式是相反的。
结论：设有HPACT项目的VHA机构似乎为无家可归的退伍军人提供了比非无家可归的退伍军人更好的初级医疗保健体验，扭转了通常与无家可归相关的相对较差的初级医疗保健体验模式。
Background:Homeless patients describe poor experiences with primary care. In 2012, the Veterans Health Administration (VHA) implemented homeless-tailored primary care teams (Homeless Patient Aligned Care Team, HPACTs) that could improve the primary care experience for homeless patients.Objective:To assess differences in primary care experiences between homeless and nonhomeless Veterans receiving care in VHA facilities that had HPACTs available (HPACT facilities) and in VHA facilities lacking HPACTs (non-HPACT facilities).Research Design:We used multivariable multinomial regressions to estimate homeless versus nonhomeless patient differences in primary care experiences (categorized as negative/moderate/positive) reported on a national VHA survey. We compared the homeless versus nonhomeless risk differences (RDs) in reporting negative or positive experiences in 25 HPACT facilities versus 485 non-HPACT facilities.Subjects:Survey respondents from non-HPACT facilities (homeless: n=10,148; nonhomeless: n=309,779) and HPACT facilities (homeless: n=2022; nonhomeless: n=20,941).Measures:Negative and positive experiences with access, communication, office staff, provider rating, comprehensiveness, coordination, shared decision-making, and self-management support.Results:In non-HPACT facilities, homeless patients reported more negative and fewer positive experiences than nonhomeless patients. However, these patterns of homeless versus nonhomeless differences were reversed in HPACT facilities for the domains of communication (positive experience RDs in non-HPACT versus HPACT facilities=-2.0 and 2.0, respectively); comprehensiveness (negative RDs=2.1 and -2.3), shared decision-making (negative RDs=1.2 and -1.8), and self-management support (negative RDs=0.1 and -4.5; positive RDs=0.5 and 8.0).Conclusions:VHA facilities with HPACT programs appear to offer a better primary care experience for homeless versus nonhomeless Veterans, reversing the pattern of relatively poor primary care experiences often associated with homelessness.