{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,1]],"date-time":"2026-06-01T14:00:15Z","timestamp":1780322415002,"version":"3.54.1"},"reference-count":20,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2018,7,1]],"date-time":"2018-07-01T00:00:00Z","timestamp":1530403200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"funder":[{"name":"VA Office of Academic Affiliations Associated Health Professions Post-Doctoral Fellow in Medical Informatics"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Substance Abuse"],"published-print":{"date-parts":[[2018,7]]},"abstract":"<jats:p>Background: The Veterans Health Administration (VHA) established a patient-centered medical home model of care for veterans experiencing homelessness called a Homeless Patient Aligned Care Team (HPACT) to improve engagement with primary care and reduce utilization of hospital-based services. To evaluate the impact of the HPACT model, this study compares the number and type of health care visits in the 12\u00a0months before and after enrollment in HPACT at one VHA facility, and explores patient characteristics associated with increases and decreases in visits. Methods: Chart reviews of VHA medical records were conducted for all patients enrolled in an HPACT in Pittsburgh, Pennsylvania, between May 2012 and December 2013 ( N = 179). Multivariable mixed-effect logistic regressions estimated differences in having any visit in the 0\u20136\u00a0months and 7\u201312\u00a0months before and after HPACT enrollment, and multinomial logistic regressions predicted increases or decreases versus no change in number of visits over 12\u00a0months. Results: Compared with 0\u20136\u00a0months prior to HPACT, patients were more likely to visit primary care in the 0\u20136\u00a0months (adjusted odds ratio [aOR] = 4.91, 95% confidence interval [CI] = 2.94\u20138.20) and 7\u201312\u00a0months (aOR = 2.30, 95% CI = 1.42\u20133.72) following HPACT. Patients were less likely to visit the emergency department (ED) or to be hospitalized in the 0\u20136\u00a0months (aOR = 0.57, 95% CI = 0.34\u20130.94; and aOR = 0.55, 95% CI = 0.25\u20130.76) and 7\u201312\u00a0months (aOR = 0.43, 95% CI = 0.33\u20130.91; and aOR = 0.45, 95% CI = 0.26\u20130.80) following HPACT. Patients were less likely to visit mental health (aOR = 0.35, 95% CI = 0.20\u20130.60) and addiction specialists (aOR = 0.39, 95% CI = 0.18\u20130.84) in the 7\u201312\u00a0months following HPACT. Overall, 59% of patients had increases in primary care visits following HPACT. Female patients and those with self-housing were less likely to have increases versus no change in primary care visits (adjusted relative risk ratio [aRRR] = 0.15, 95% CI = 0.03\u20130.74; and aRRR = 0.35, 95% CI = 0.14\u20130.90). Conclusions: An integrated HPACT model was successful in engaging homeless veterans in primary care for 1\u00a0year, potentially contributing to reductions in ED use. More tailored approaches may be needed for vulnerable populations experiencing homelessness, including homeless women.<\/jats:p>","DOI":"10.1080\/08897077.2018.1437500","type":"journal-article","created":{"date-parts":[[2018,2,7]],"date-time":"2018-02-07T11:09:13Z","timestamp":1518001753000},"page":"354-360","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":16,"title":["Patient Predictors and Utilization of Health Services within a Medical Home for Homeless Persons"],"prefix":"10.1177","volume":"39","author":[{"given":"Audrey L.","family":"Jones","sequence":"first","affiliation":[{"name":"Informatics, Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roxanne","family":"Thomas","sequence":"additional","affiliation":[{"name":"Providence Milwaukie Hospital, Milwaukie, Oregon, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel O.","family":"Hedayati","sequence":"additional","affiliation":[{"name":"University of Pittsburgh, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaddy K.","family":"Saba","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Conley","sequence":"additional","affiliation":[{"name":"Center for Health Equity Research and Promotion (CHERP), VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2453-8871","authenticated-orcid":false,"given":"Adam J.","family":"Gordon","sequence":"additional","affiliation":[{"name":"Informatics, Decision-Enhancement and Analytic Sciences (IDEAS 2.0) Center of Innovation, VA Salt Lake City Health Care System, Salt Lake City, Utah, USA"},{"name":"Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City, Utah, USA"},{"name":"Department of Psychiatry, University of Utah School of Medicine, Salt Lake City, Utah, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2018,7,1]]},"reference":[{"key":"bibr1-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e3181a469b0"},{"key":"bibr2-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.1177\/1077558712447688"},{"key":"bibr3-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2828-7"},{"key":"bibr4-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-014-2835-8"},{"key":"bibr5-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301632"},{"key":"bibr6-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.1007\/s11606-011-1818-2"},{"key":"bibr7-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0000000000000207"},{"key":"bibr8-08897077.2018.1437500","doi-asserted-by":"publisher","DOI":"10.1177\/2150131914556122"},{"issue":"10","key":"bibr9-08897077.2018.1437500","first-page":"10","volume":"31","author":"Gabrielian S","year":"2014","journal-title":"Fed Pract."},{"key":"bibr10-08897077.2018.1437500","first-page":"E44","volume":"13","author":"O'Toole TP","year":"2016","journal-title":"Prev Chronic Dis."},{"key":"bibr11-08897077.2018.1437500","unstructured":"Gordon A. 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