Organizational and patient factors associated with positive primary care experiences for veterans with current or recent homelessness.

Autor: Kertesz SG; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA., deRussy AJ; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA., Hoge AE; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA., Varley AL; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA., Holmes SK; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA., Riggs KR; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA., Austin EL; University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA., Gordon AJ; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA., Gabrielian SE; HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, Los Angeles, California, USA.; Department of Psychiatry and Biobehavioral Sciences, David Geffen School of Medicine, University of California, Los Angeles, Neuropsychiatric Institute, Los Angeles, California, USA., Pollio DE; University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA.; Tampa, Florida, USA., Montgomery AE; University of Alabama at Birmingham School of Public Health, Birmingham, Alabama, USA., Gelberg L; HSR&D Center for the Study of Healthcare Innovation, Implementation & Policy (CSHIIP), VA Greater Los Angeles Healthcare System, Los Angeles, Los Angeles, California, USA.; Department of Family Medicine, University of California Los Angeles, Los Angeles, California, USA., Steward JL; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham School of Health Professions, Birmingham, Alabama, USA.; Leidos, Inc. (Reston, VA), Reston, Virginia, USA.; Department of Health and Human Services (DHHS), Administration for Strategic Preparedness & Response (ASPR), Office of National Readiness & Response (ONRR), Division of Strategic National Stockpile (DSNS), Atlanta, Georgia, USA., Jones AL; Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA.; Program for Addiction Research, Clinical Care, Knowledge and Advocacy (PARCKA), Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA., Richman JR; Birmingham Alabama Veterans Health Care System, Birmingham, Alabama, USA.; University of Alabama at Birmingham Heersink School of Medicine, Birmingham, Alabama, USA.
Jazyk: angličtina
Zdroj: Health services research [Health Serv Res] 2024 Dec; Vol. 59 (6), pp. e14359. Date of Electronic Publication: 2024 Aug 06.
DOI: 10.1111/1475-6773.14359
Abstrakt: Objective: To identify organizational service features associated with positive patient ratings of primary care within primary care clinics tailored to accommodate persons with ongoing and recent experiences of homelessness (PEH).
Data Sources and Study Setting: PEH receiving primary care in 29 United States Veterans Health Administration homeless-tailored clinics were surveyed about their primary care experience using the validated Primary Care Quality-Homeless (PCQ-H) survey. Characteristics of the clinics were assessed through surveys of clinic staff using a new organizational survey developed through literature review, site visits, statistical analysis, and consensus deliberation.
Study Design: Cross-sectional examination of patients' ratings of care based on surveys of patients, and of clinic characteristics, analyzed with Classification and Regression Tree (CART) analysis, a form of machine learning.
Data Collection Methods: Patient surveys (n = 3394) were obtained from a random sample of enrolled patients by both mail and telephone by an external survey contractor. Staff (n = 52 from 29 clinics) were interviewed by telephone.
Principal Findings: This analysis identified service features that impact patient experience favorably, including aspects of patient-centeredness, team identity, strong external leadership support, and service that reach beyond traditional primary care clinic confines. Results varied according to the patient experience scale analyzed. Individual characteristics of PEH, such as degree of social support, general health, and unsheltered status, were also correlated with how they rate care.
Conclusions: Organizational characteristics correlate with ratings of primary care from patients with recent and ongoing homelessness. Primary care programs serving homeless individuals can assure better care based on who they hire, how they foster team identity, what services they provide, and the strength of leadership support to protect a homeless-focused mission.
(© 2024 The Author(s). Health Services Research published by Wiley Periodicals LLC on behalf of Health Research and Educational Trust. This article has been contributed to by U.S. Government employees and their work is in the public domain in the USA.)
Databáze: MEDLINE
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