Applying the Chronic Care Model to Homeless Veterans: Effect of a Population Approach to Primary Care on Utilization and Clinical Outcomes

Abstract

Tailoring primary care to homeless veterans can decrease unnecessary ED use and medical admissions and improve chronic disease management.

Preliminary needs assessment of mobile technology use for healthcare among homeless veterans

“…3 The study 30 also reported that mental health related conditions were highly prevalent, with 71% suffering 31 from alcohol abuse, 67% with depression, 43% cocaine use, 37% anxiety, 17% heroin use, and 32 11% bipolar disorder.…”

Building Care Systems to Improve Access for High-Risk and Vulnerable Veteran Populations

“…The intensive treatment arm had increased primary care use with rates similar to those noted in our study and higher readmission rates but, unlike our study, longer lengths of stay 23 . Other research on homeless veterans noted reductions in emergency department use 24 and emergency department and inpatient use 25 with tailored clinic models, but only after the patients had been enrolled in the program for a least 6 months and in one study 18 months. Studies evaluating the Program of All-Inclusive Care for the Elderly (PACE) models found lower than predicted short term hospital use but with much inter-facility variation suggesting site-specific organization and management practices have an independent effect these findings 26 .…”

Differential Impact of Homelessness on Glycemic Control in Veterans with Type 2 Diabetes Mellitus

“…O'Toole and colleagues (2010) also report reductions in risk for emergency department and inpatient usage among homeless Veterans with higher levels of primary care engagement. 4 This analysis should be interpreted in light of certain limitations. First, we analyzed a retrospective cohort of Veterans with type 2 diabetes mellitus using diagnostic and administrative codes to identify subjects at high likelihood for having had an episode of homelessness.…”

“…3 Homelessness is associated with high rates of mental health disorders and substance abuse, but chronic health conditions are also prevalent in this population. 4 In one report, 61 % of homeless subjects reported having psychiatric problems and 79 % reported alcohol or drug abuse or dependence. In addition, 66 % of homeless subjects enrolling for medical care reported having at least one chronic medical condition.…”