Applying the chronic care model to homeless veterans: effect of a population approach to primary care on utilization and clinical outcomes.
OBJECTIVE
We compared a population-tailored approach to primary care for homeless veterans with a usual care approach.


METHODS
We conducted a retrospective prolective cohort study of homeless veterans enrolled in a population-tailored primary care clinic matched to a historical sample in general internal medicine clinics. Overall, 177 patients were enrolled: 79 in the Homeless-Oriented Primary Care Clinic and 98 in general internal medicine primary care.


RESULTS
Homeless-oriented primary care-enrolled patients had greater improvements in hypertension, diabetes, and lipid control, and primary care use was higher during the first 6 months (5.96 visits per person vs 1.63 for general internal medicine) but stabilized to comparable rates during the second 6 months (2.01 vs 1.31, respectively). Emergency department (ED) use was also higher (2.59 vs 1.89 visits), although with 40% lower odds for nonacute ED visits than for the general internal medicine group (95% confidence interval = 0.2, 0.8). Excluding substance abuse and mental health admissions, hospitalizations were reduced among the homeless veterans between the 2 periods (28.6% vs 10.8%; P < .01) compared with the general internal medicine group (48.2% vs 44.4%; P = .6; difference of differences, P < .01).


CONCLUSIONS
Tailoring primary care to homeless veterans can decrease unnecessary ED use and medical admissions and improve chronic disease management.
Providence Veterans Affairs Medical Center for Systems, Outcomes, and Quality in Chronic Disease and Rehabilitation, Providence, RI 02908-4799, USA. thomas.otoole@va.gov
Thomas P
TP
O'Toole
Lauren
L
Buckel
Claire
C
Bourgault
Jonathan
J
Blumen
Stephen G
SG
Redihan
Lan
L
Jiang
Peter
P
Friedmann
D002908:Chronic Disease / Q000628:therapy*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data*; D005260:Female; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D008134:Long-Term Care; D008297:Male; D008875:Middle Aged; D011320:Primary Health Care / Q000458:organization & administration*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014728:Veterans / Q000706:statistics & numerical data