title: New to care: demands on a health system when homeless veterans are enrolled in a medical home model.
abstract: OBJECTIVE
  We compared service use among homeless and nonhomeless veterans newly enrolled in a medical home model and identified patterns of use among homeless veterans associated with reductions in emergency department (ED) use.
  
  
  METHODS
  We used case-control matching with a nested cohort analysis to measure 6-month health services use, new diagnoses, and care use patterns in veterans at the Providence, Rhode Island, Veterans Affairs Medical Center from 2008 to 2011.
  
  
  RESULTS
  We followed 127 homeless and 106 nonhomeless veterans. Both groups had similar rates of chronic medical and mental health diagnoses; 25.4% of the homeless and 18.1% of the nonhomeless group reported active substance abuse. Homeless veterans used significantly more primary, mental health, substance abuse, and ED care during the first 6 months. Homeless veterans who accessed primary care at higher rates (relative risk ratio [RRR] = 1.46; 95% confidence interval [CI] = 1.11, 1.92) or who used specialty and primary care (RRR = 10.95; 95% CI = 1.58, 75.78) had reduced ED usage. Homeless veterans in transitional housing or doubled-up at baseline (RRR = 3.41; 95% CI = 1.24, 9.42) had similar reductions in ED usage.
  
  
  CONCLUSIONS
  Homeless adults had substantial health needs when presenting for care. High-intensity primary care and access to specialty care services could reduce ED use.
authors.affiliation: Thomas P. O'Toole, Claire Bourgault, Erin E. Johnson, Stephen G. Redihan, and Matthew Borgia are with the Providence Veterans Affairs (VA) Medical Center, Warren Alpert Medical School at Brown University, and VA National Center on Homelessness Among Veterans, Providence, RI. Riccardo Aiello and Vincent Kane are with the National Center on Homeless Among Veterans, Providence. Vincent Kane is also a guest editor for this supplement issue.
authors.forename: Thomas P
authors.initials: TP
authors.lastname: O'Toole
authors.forename: Claire
authors.initials: C
authors.lastname: Bourgault
authors.forename: Erin E
authors.initials: EE
authors.lastname: Johnson
authors.forename: Stephen G
authors.initials: SG
authors.lastname: Redihan
authors.forename: Matthew
authors.initials: M
authors.lastname: Borgia
authors.forename: Riccardo
authors.initials: R
authors.lastname: Aiello
authors.forename: Vincent
authors.initials: V
authors.lastname: Kane
mesh_terms: D000328:Adult; D002908:Chronic Disease; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006296:Health Services / Q000706:statistics & numerical data*; D006304:Health Status; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D018802:Patient-Centered Care / Q000458:organization & administration* / Q000706:statistics & numerical data*; D011320:Primary Health Care / Q000706:statistics & numerical data; D012237:Rhode Island; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration / Q000706:statistics & numerical data; D014728:Veterans / Q000706:statistics & numerical data*