{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,29]],"date-time":"2026-09-29T11:22:53Z","timestamp":1790680973524,"version":"4.1.0"},"reference-count":48,"publisher":"MDPI AG","issue":"12","license":[{"start":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T00:00:00Z","timestamp":1763683200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"the F. W. Bert and Mae Dean Wheeler Foundation"},{"name":"the Hawkins Family Foundation"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Nursing Reports"],"abstract":"<jats:p>Background\/Objectives: Homeless populations have higher rates of chronic illness and mortality than more advantaged peers but have low primary care engagement. Nurse-managed clinics emerged as a possible solution to increase healthcare access for marginalized populations. This paper presents a comprehensive evaluation of feasibility (conceptualized as patient recruitment and retention) and acceptability (conceptualized as patient satisfaction) of a nurse-managed primary care clinic tailored to people experiencing homelessness and poverty. Methods: This is a three-year retrospective chart review study of the clinic\u2019s services, patient characteristics, and patient satisfaction. All adult patients for the three-year period were included (N = 514). Feasibility was measured by the number of unique patients seen and visits completed, ratio of completed to scheduled visits, and number of returning patients. Acceptability was measured by a 19-item Likert format (1\u20135) patient satisfaction survey. Patient characteristics were captured from intake forms. Results: Most patients were male, African American or White, and non-Hispanic. Regarding social determinants of health (SDOH), most patients did not have college education, were unemployed or unable to work, experienced homelessness, had no primary care provider, and no health insurance. Over three years, 1972 visits were scheduled and 1372 (69.6%) completed. A total of 514 patients were seen (37.5% of all visits), with 858 follow-up visits (62.5%). Returning patients (\u22652 visits) totaled 59.1%. Yearly data shows steady growth in recruitment and retention. Patient satisfaction with facets of care (access, communication, interpersonal relations) was very high (Mrange = 4.63\u20134.69), including with Nurse Practitioner care, as was global satisfaction (M = 4.71; SD = 0.61; 76.3% very satisfied). Conclusions: Results indicate that a homeless-tailored nurse-managed clinic can recruit and retain homeless and working poor patients (feasibility), with high patient satisfaction with its services and staff (acceptability), independently of patient demographics or SDOH. Challenges related to retention deserve further study as well as the impact of services on the continuity of care, health, and well-being.<\/jats:p>","DOI":"10.3390\/nursrep15120412","type":"journal-article","created":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T15:33:06Z","timestamp":1763739186000},"page":"412","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["A Comprehensive Evaluation of Feasibility and Acceptability of a Nurse-Managed Health Clinic for Homeless and Working Poor Populations: A 3-Year Study"],"prefix":"10.3390","volume":"15","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0746-0830","authenticated-orcid":false,"given":"Teresa M.","family":"McIntyre","sequence":"first","affiliation":[{"name":"Andy and Barbara Gessner College of Nursing, University of Houston, 14000 University Boulevard, Sugarland, TX 77479, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-6617-9824","authenticated-orcid":false,"given":"Shainy B.","family":"Varghese","sequence":"additional","affiliation":[{"name":"Andy and Barbara Gessner College of Nursing, University of Houston, 14000 University Boulevard, Sugarland, TX 77479, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9391-0972","authenticated-orcid":false,"given":"William Pat","family":"Taylor","sequence":"additional","affiliation":[{"name":"Texas Institute for Measurement, Evaluation, and Statistics, University of Houston, Houston, TX 77204, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,11,21]]},"reference":[{"key":"ref_1","unstructured":"De Sousa, T., and Henry, M. (2025, September 09). The 2024 Annual Homelessness Assessment Report (AHAR) to Congress. Part 1: Point-In-Time Estimates of Homelessness. The U.S. Department of Housing and Urban Development, Available online: https:\/\/www.huduser.gov\/portal\/publications\/2024-ahar-part-1-pit-estimates-of-homelessness.html."},{"key":"ref_2","unstructured":"Soucy, D., Janes, M., and Hall, A. (2025). State of Homelessness: 2025 Edition, National Alliance to End Homelessness."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"100043","DOI":"10.1016\/j.focus.2022.100043","article-title":"Unsheltered homelessness and health: A literature review","volume":"2","author":"Richards","year":"2023","journal-title":"AJPM Focus"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"476","DOI":"10.1111\/1753-6405.13038","article-title":"Long-term effects of homelessness on mortality: A 15-year Australian cohort study","volume":"44","author":"Seastres","year":"2020","journal-title":"Aust. N. Z. J. Public Health"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"e1909","DOI":"10.7717\/peerj.1909","article-title":"Six-year mortality in a street-recruited cohort of homeless youth in San Francisco, California","volume":"4","author":"Auerswald","year":"2016","journal-title":"PeerJ"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"448","DOI":"10.1111\/hsc.13486","article-title":"The physical and mental health effects of housing homeless people: A systematic review","volume":"30","author":"Onapa","year":"2022","journal-title":"Health Soc. Care Community"},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1529","DOI":"10.1016\/S0140-6736(14)61132-6","article-title":"The health of homeless people in high income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations","volume":"384","author":"Fazel","year":"2014","journal-title":"Lancet"},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2150132720910568","DOI":"10.1177\/2150132720910568","article-title":"Comparing the impact of primary care practice design in two inner city UK homelessness services","volume":"11","author":"Zeitler","year":"2020","journal-title":"J. Prim. Care Community Health"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1177\/2150131914556122","article-title":"Access to primary care services among the homeless: A synthesis of the literature using equity of access to medical care framework","volume":"6","author":"White","year":"2015","journal-title":"J. Prim. Care Community Health"},{"key":"ref_10","unstructured":"US Department of Health and Human Services: Office of Disease Prevention and Health Promotion (2025, July 16). Healthy People 2030: Social Determinants of Health, Available online: https:\/\/odphp.health.gov\/healthypeople\/priority-areas\/social-determinants-health."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Currie, J., Stafford, A., Hutton, J., and Wood, L. (2023). Optimising access to healthcare for patients experiencing homelessness in hospital emergency departments. Int. J. Environ. Res. Public Health, 20.","DOI":"10.3390\/ijerph20032424"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"2560","DOI":"10.1007\/s11606-020-06029-0","article-title":"Hospital Readmission and Emergency Department Revisits of Homeless Patients Treated at Homeless-Serving Hospitals in the USA: Observational Study","volume":"35","author":"Miyawaki","year":"2020","journal-title":"J. Gen. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1115","DOI":"10.1111\/phn.13068","article-title":"Innovation and partnerships: Meeting the health care needs of a houseless population","volume":"39","author":"Fox","year":"2022","journal-title":"Public. Health Nurs."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1080\/10530789.2022.2080794","article-title":"Healing the homelessness, fixing a broken aid industry, and challenging the status quo: Perspectives of a physician-activist","volume":"33","author":"Peoples","year":"2022","journal-title":"J. Soc. Distress Homelessness"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"2150132721993654","DOI":"10.1177\/2150132721993654","article-title":"Enhancing primary care experiences for homeless patients with serious mental illness: Results from a national survey","volume":"12","author":"Gabrielan","year":"2021","journal-title":"J. Prim. Care Community Health"},{"key":"ref_16","doi-asserted-by":"crossref","unstructured":"Kaufman, R.A., Mallick, M., Louis, J.T., Williams, M., and Oriol, N. (2024). The role of street medicine and mobile clinics for persons experiencing homelessness: A scoping review. Int. J. Environ. Res. Public Health, 21.","DOI":"10.3390\/ijerph21060760"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"21501327211037532","DOI":"10.1177\/21501327211037532","article-title":"Filling gaps and setting boundaries: Examining utilization of health and social services as JeffHOPE student run clinics","volume":"12","author":"Wang","year":"2021","journal-title":"J. Prim. Care Community Health"},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"5","DOI":"10.1038\/s41572-020-00241-2","article-title":"Health care for homeless people","volume":"7","author":"Liu","year":"2021","journal-title":"Nat. Rev. Dis. Primers"},{"key":"ref_19","first-page":"12","article-title":"Nurse-led health clinics show positive outcomes","volume":"118","author":"Sofer","year":"2018","journal-title":"Am. J. Nurs."},{"key":"ref_20","unstructured":"Young, H., McNeal, G., and Reinhard, S. (2025, July 16). Modernization of California Nurse Practitioner Practice is Overdue: Implications for Nurse-Led Clinics. The Institute of Nursing: Campaign for Action, 18 November 2020. Available online: https:\/\/campaignforaction.org\/implications-for-nurse-led-clinics\/."},{"key":"ref_21","unstructured":"National Academies of Sciences, Engineering, and Medicine (NASEM) (2021). Implementing High-Quality Primary Care: Rebuilding the Foundation of Health Care, The National Academies Press."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"137","DOI":"10.1097\/NAQ.0000000000000518","article-title":"Breaking Down Institutional Barriers to Advanced Practice Registered Nurse Practice","volume":"46","author":"Kleinpell","year":"2022","journal-title":"Nurs. Adm. Q."},{"key":"ref_23","unstructured":"AANP (2021). 2021 Nurse Practitioner State Practice Environment, American Association of Nurse Practitioners."},{"key":"ref_24","unstructured":"Boehning, A.P., and Punsalan, L.D. (2025). Advanced Practice Registered Nurse Roles. StatPearls [Internet], StatPearls Publishing."},{"key":"ref_25","unstructured":"AANP (2025, June 20). Scope of Practice for Nurse Practitioners. Available online: https:\/\/www.aanp.org\/advocacy\/advocacy-resource\/position-statements\/scope-of-practice-for-nurse-practitioners."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2150131917747186","DOI":"10.1177\/2150131917747186","article-title":"Nursing Practice in Primary Care and Patients\u2019 Experience of Care","volume":"9","author":"Brault","year":"2018","journal-title":"J. Prim. Care Community Health"},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"74","DOI":"10.1186\/s12960-024-00956-3","article-title":"Effects of task-shifting from primary care physicians to nurses: An overview of systematic reviews","volume":"22","author":"Posch","year":"2024","journal-title":"Hum. Resour. Health"},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"244","DOI":"10.1177\/08404704241229075","article-title":"Evaluating the cost of NP-led vs. GP-led primary care in British Columbia","volume":"37","author":"Contandriopoulos","year":"2024","journal-title":"Healthc. Manag. Forum"},{"key":"ref_29","first-page":"CD001271","article-title":"Nurses as substitutes for doctors in primary care","volume":"2019","author":"Laurant","year":"2018","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_30","unstructured":"The Patient Protection and Affordable Care Act (2025, September 25). Public law No. 111\u2013148, 124 Stat.119, 2010, Available online: https:\/\/www.congress.gov\/bill\/111th-congress\/house-bill\/3590."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"428","DOI":"10.1016\/j.outlook.2014.06.005","article-title":"Evidence-based characteristics of nurse-managed health centers for quality and outcomes","volume":"62","author":"Holt","year":"2014","journal-title":"Nurs. Outlook"},{"key":"ref_32","unstructured":"McIntyre, T., Varghese, S., Taylor, P., and Ward, J. (2024). University of Houston College of Nursing Program Evaluation Report: Serving the Working Poor and those Experiencing Homelessness in Midtown Houston, Andy and Barbara Gessner College of Nursing, University of Houston."},{"key":"ref_33","unstructured":"Coalition for the Homeless Houston\/Harris County (2025). 2025 Point-in-Time Count & Survey of People Experiencing Homelessness, Coalition for the Homeless Houston\/Harris County."},{"key":"ref_34","unstructured":"National Nurse-Led Care Consortium (2025, September 30). Nurse-led Health Care and Health Centers: A Brief Overview of Nurse-Led Care Models and Their Role in Primary Care. National Nurse-Led Care Consortium. Available online: https:\/\/nurseledcare.phmc.org\/images\/pdf\/nttap\/2022_NNCC%20Publication_NurseManagedHealthCenters.pdf."},{"key":"ref_35","unstructured":"Polit, D.F., and Beck, C.T. (2021). Essentials of nursing research, Lippincott Williams and Wilkins. [10th ed.]."},{"key":"ref_36","unstructured":"Varghese, S., and McIntyre, T. (2021). UH College of Nursing Health Clinic Patient Intake Form, University of Houston."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"452","DOI":"10.1016\/j.amepre.2009.02.002","article-title":"How we design feasibility studies","volume":"36","author":"Bowen","year":"2009","journal-title":"Am. J. Prev. Med."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"1258","DOI":"10.1002\/nop2.1437","article-title":"Elements of patient satisfaction: An integrative review","volume":"10","author":"Goodrich","year":"2023","journal-title":"Nurs. Open"},{"key":"ref_39","unstructured":"McIntyre, T. (2021). Patient Satisfaction Questionnaire\u2014Brief (PSQ-B), University of Houston."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"49","DOI":"10.12688\/wellcomeopenres.15151.1","article-title":"Causes of death among homeless people: A population-based cross-sectional study of linked hospitalisation and mortality data in England","volume":"4","author":"Aldridge","year":"2019","journal-title":"Wellcome Open Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"357","DOI":"10.1001\/jamainternmed.2019.6010","article-title":"Disparities in Care and Mortality Among Homeless Adults Hospitalized for Cardiovascular Conditions","volume":"180","author":"Wadhera","year":"2020","journal-title":"JAMA Intern. Med."},{"key":"ref_42","doi-asserted-by":"crossref","unstructured":"Magwood, O., Leki, V.Y., Kpade, V., Saad, A., Alkhateeb, Q., Gebremeskel, A., Rehman, A., Hannigan, T., Pinto, N., and Sun, A.H. (2019). Common trust and personal safety issues: A systematic review on the acceptability of health and social interventions for persons with lived experience of homelessness. PLoS ONE, 14.","DOI":"10.1371\/journal.pone.0226306"},{"key":"ref_43","unstructured":"American Association of Nurse Practitioners (2025). Issues at a Glance: Full Practice Authority, American Association of Nurse Practitioners."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"f3345","DOI":"10.1136\/bmj.f3345","article-title":"Selection bias versus allocation bias","volume":"346","author":"Sedgwick","year":"2013","journal-title":"BMJ"},{"key":"ref_45","doi-asserted-by":"crossref","unstructured":"Murdoch, M., Simon, A.B., Polusny, M.A., Bangerter, A.K., Grill, J.P., Noorbaloochi, S., and Partin, M.R. (2014). Impact of different privacy conditions and incentives on survey response rate, participant representativeness, and disclosure of sensitive information: A randomized controlled trial. BMC Med. Res. Methodol., 14.","DOI":"10.1186\/1471-2288-14-90"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"3587","DOI":"10.1111\/jan.15387","article-title":"Scoping review: Scope of practice of nurse-led services and access to care for people experiencing homelessness","volume":"78","author":"McWilliams","year":"2022","journal-title":"J. Adv. Nurs."},{"key":"ref_47","doi-asserted-by":"crossref","unstructured":"Ortiz, A.K., Wright, W., and Romboli, J. (J. Am. Assoc. Nurse Pract., 2025). Reimagining primary care delivery: Evaluation of nurse practitioner\u2013owned primary care practices, J. Am. Assoc. Nurse Pract., ahead of printing.","DOI":"10.1097\/JXX.0000000000001192"},{"key":"ref_48","first-page":"322","article-title":"Nurse practitioner-owned practices and value-based payment","volume":"34","author":"Perloff","year":"2021","journal-title":"J. Am. Assoc. Nurse Pract."}],"container-title":["Nursing Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/12\/412\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,21]],"date-time":"2025-11-21T15:46:24Z","timestamp":1763739984000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2039-4403\/15\/12\/412"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,11,21]]},"references-count":48,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2025,12]]}},"alternative-id":["nursrep15120412"],"URL":"https:\/\/doi.org\/10.3390\/nursrep15120412","relation":{},"ISSN":["2039-4403"],"issn-type":[{"value":"2039-4403","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,11,21]]}}}