title: Feasibility and Acceptability of a Colocated Homeless-Tailored Primary Care Clinic and Emergency Department.
abstract: OBJECTIVE
  Homeless adults have low primary care engagement and high emergency department (ED) utilization. Homeless-tailored, patient-centered medical homes (PCMH) decrease this population's acute care use. We studied the feasibility (focused on patient recruitment) and acceptability (conceptualized as clinicians' attitudes/beliefs) of a pilot initiative to colocate a homeless-tailored PCMH with an ED. After ED triage, low-acuity patients appropriate for outpatient care were screened for homelessness; homeless patients chose between a colocated PCMH or ED visit.
  
  
  METHODS
  To study feasibility, we captured (from May to September 2012) the number of patients screened for homelessness, positive screens, unique patients seen, and primary care visits. We focused on acceptability to ED clinicians (physicians, nurses, social workers); we sent a 32-item survey to ED clinicians (n = 57) who worked during clinic hours. Questions derived from an instrument measuring clinician attitudes toward homeless persons; acceptability of homelessness screening and the clinic itself were also explored.
  
  
  RESULTS
  Over the 5 months of interest, 281 patients were screened; 172 (61.2%) screened positive for homelessness; 112 (65.1%) of these positive screens were seen over 215 visits. Acceptability data were obtained from 56% (n = 32) of surveyed clinicians. Attitudes toward homeless patients were similar to prior studies of primary care physicians. Most (54.6%) clinicians agreed with the homelessness screening procedures. Nearly all (90.3%) clinicians supported expansion of the homeless-tailored clinic; a minority (42.0%) agreed that ED colocation worked well.
  
  
  CONCLUSIONS
  Our data suggest the feasibility of recruiting patients to a homeless-tailored primary care clinic colocated with the ED; however, the clinic's acceptability was mixed. Future quality improvement work should focus on tailoring the clinic to increase its acceptability among ED clinicians, while assessing its impact on health, housing, and costs.
authors.affiliation: 1 VA Greater Los Angeles, Los Angeles, CA, USA.|2 UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
authors.forename: Sonya
authors.initials: S
authors.lastname: Gabrielian
authors.affiliation: 2 UCLA David Geffen School of Medicine, Los Angeles, CA, USA.|3 Harbor-UCLA Medical Center, Torrance, CA, USA.
authors.forename: Jennifer C
authors.initials: JC
authors.lastname: Chen
authors.affiliation: 4 MedAmerica, New York, NY, USA.
authors.forename: Beena P
authors.initials: BP
authors.lastname: Minhaj
authors.affiliation: 5 HealthBegins, Los Angeles, CA, USA.
authors.forename: Rishi
authors.initials: R
authors.lastname: Manchanda
authors.affiliation: 1 VA Greater Los Angeles, Los Angeles, CA, USA.|2 UCLA David Geffen School of Medicine, Los Angeles, CA, USA.
authors.forename: Lisa
authors.initials: L
authors.lastname: Altman
authors.affiliation: 1 VA Greater Los Angeles, Los Angeles, CA, USA.
authors.forename: Ella
authors.initials: E
authors.lastname: Koosis
authors.affiliation: 1 VA Greater Los Angeles, Los Angeles, CA, USA.|2 UCLA David Geffen School of Medicine, Los Angeles, CA, USA.|6 UCLA Fielding School of Public Health, Los Angeles, CA, USA.
authors.forename: Lillian
authors.initials: L
authors.lastname: Gelberg
mesh_terms: D000328:Adult; D000554:Ambulatory Care Facilities / Q000458:organization & administration*; D001291:Attitude of Health Personnel; D004635:Emergency Medicine; D016529:Emergency Nursing; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005240:Feasibility Studies; D005260:Female; D006703:Ill-Housed Persons; D006801:Humans; D015141:Los Angeles; D008297:Male; D008875:Middle Aged; D009726:Nurses; D009728:Nursing Assistants; D010342:Patient Acceptance of Health Care; D018802:Patient-Centered Care / Q000458:organization & administration*; D010820:Physicians; D010865:Pilot Projects; D011320:Primary Health Care / Q000458:organization & administration*; D000068217:Social Workers
keywords: emergency department; homelessness; primary care; quality improvement; veterans