Author, year Country | Title | Objective | Population/Setting | Exposure | Patient Experience Measure | Key findings related to patient experience measures and/or outcomes |
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Behl-Chadha, 2017 [37], US | Comparison of Patient Experience between a Practice for Homeless Patients and Other Practices Engaged in a Patient—Centered Medical Home Initiative | To understand how patient experience differs between a PCMH demonstration practice designed for homeless people in Massachusetts and other practices participating in the same state-wide initiative | PEH n = 194 Comparison practice patients n = 1,868 Boston Health Care for the Homeless Program (BHCHP) | Comparison with 34 non-rural practices from The Massachusetts Patient-Centered Medical Home Initiative (MA PCMHI) Primary Healthcare | Patient experience surveys were adapted from the Consumer Assessment of Healthcare Providers and Systems Clinician and Group (CG- CAHPS) survey | BHCHP patients gave higher ratings than patients from comparison practices for Self- management support (74 vs. 64; p < .001) and Behavioral health integration (74 vs. 66; p < .01). There were no statistically significant differences between the two groups on Overall rating of the provider, Providers discuss medication decisions and Follow-up on test results. BHCHP scored lower than comparison practices on How well providers communicate with patients (82 vs. 90; p < .001), Helpful, courteous and respectful office staff (76 vs. 85; p < .001), and Getting timely appointments, care, and information (69 vs. 79; p < .001) |
Gabrielian, 2021 [39] US | Enhancing Primary Care Experiences for Homeless Patients with Serious Mental Illness: Results from a National Survey | To assess if primary care teams tailored for homeless patients (Homeless-Patient Aligned Care Teams (H-PACTs) provide superior experiences than mainstream primary care and to explore whether integrated behavioural health and social services are associated with favourable experiences | PEH N = 1,095 Veterans Administration integrated healthcare system | Comparison of High integration H-PACTs (3–4 embedded services) to Low integration H-PACTs (0–2 embedded services) and to mainstream services Primary Healthcare | The Primary Care Quality-Homeless (PCQ-H) questionnaire | Homeless-tailored clinics with highly integrated services were associated with better care experiences among PEH with SMI. These observational data suggest that tailored primary care with integrated services may improve care perceptions among complex patients. In all 4 domains (Access/Coordination, Patient-Clinician Relationships, Cooperation, and Homeless-Specific Needs) high integration H-PACT respondents were significantly (P < .05) more likely than their mainstream peers to report favourable and/or less likely to report unfavourable experiences. Highly integrated clinics with embedded services were associated with favourable perceptions of clinic access/ coordination. Behavioral health services (eg. addiction services) were not associated with more favourable experiences |
Jones, 2017 [41], US | A National Evaluations of homeless and non homeless veterans’ experience with primary care | To compare the primary care experiences of homeless and non-homeless Veterans with Mental Health and/or Substance Use Disorders (MHSUDs) receiving care in the Veterans Health Administration’s medical home environment, called Patient Aligned Care Teams (PACTs) | PEH N = 4,605 Non-homeless Veterans n = 63,061 In the final weighted sample, 9.2% of Veteran respondents with MHSUDs were homeless. Veterans Health Administration (VHA), PACTs, National database | Comparison of homeless veterans and non-homeless veterans Primary Healthcare | PCMH-SHEP survey—Based on the Consumer Assessment of Healthcare Providers and Systems (CAHPS) PCMH Survey (version 2.0) | After controlling for sociodemographic and clinical characteristics Homeless Veterans reported more negative and fewer positive experiences with communication (Risk Difference (RD) = 1.74 and -3.90, respectively). Homeless Veterans also reported more negative provider ratings (RD = 1.95), comprehensiveness (RD = 2.84), care coordination (RD = 2.35), and medication decision-making (RD = 2.08). After adjusting for covariates, homeless Veterans also reported more negative experiences with self-management support (RD = 2.30). No significant differences were observed in experiences with access or office staff helpfulness/courtesy after adjusting for covariates |
Jones, 2021 [40], US | Perceptions of care coordination among homeless veterans receiving medical care in the veterans health administration and a community care setting results from a national survey | To evaluate community care use and satisfaction, and compare perceptions of care coordination among Veterans with homeless experience using VHA services and community care to those using VHA services without community care | PEH N = 4777 PEH using VHA services and community care n = 1,325 (26.7%) PEH using VHA services without community care n = 3,452 (73.3%) Veterans Health Administration (VHA), Community Care Veterans Choice Program | Comparison of homeless veterans using VHA services and community care and those using VHA services without community care Primary Healthcare | The Primary Care Quality-Homeless (PCQ-H) survey (Experiences with Access/Care Coordination) Self-reported use of community care Satisfaction with Community Care | Of 4777 respondents, 1325 (26.7%) reported using community care; most of this subsample affirmed satisfaction with the community care they received (83%) and its timeliness (75%). Satisfaction with community care was lower among patients with travel barriers, psychological distress, and less social support Compared to those using the Veterans Health Administration(VHA) services without community care, Veterans using VHA services and community care were more likely to report unfavorable access/coordination experiences ([OR] = 1.34, CI = 1.15–1.57). This included hassles following referral (OR = 1.37, CI = 1.14–1.65) and perceived delays in receiving health care (OR = 1.38, CI = 1.19–1.61) |
Kertesz, 2013 [43], US | Comparing homeless persons’ care experiences in tailored versus non tailored primary care programs | To compare homeless patients’ experiences of care in health care organisations that differed in their degree of primary care design service tailoring | PEH N = 601 VA mainstream Primary Healthcare settings, homeless -tailored VA PHC clinic, and a tailored non-VA Health Care for the Homeless Program | Comparison of VA mainstream PHC settings, homeless-tailored VA PHC clinic and a tailored non-VA Health Care for the Homeless Program Primary Healthcare | The Primary Care Quality—Homeless (PCQ-H) Survey (mail and telephone contact) | Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness. Scores at the tailored non-VA site were higher (reflecting more positive experience with care) than those at the 3 mainstream VA sites. After adjusting for patient characteristics, differences remained significant for the relationship (P < .001) and cooperation (P = .005) subscales, whereas they fell short of statistical significance in the case of access or coordination (P = .055) and homeless-specific needs (P = .21). There were 1.5- to threefold increased odds of an unfavourable experience in the domains of the patient–clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results |
Kertesz, 2021 [42], US | Comparison of patient experience between primary care settings tailored for homeless clientele and mainstream care settings | To examine whether homeless-tailored primary care programs offer a superior patient experience compared to non-tailored (“mainstream”) programs overall, and for highly vulnerable patients | PEH N = 5766 VA, 26 National Medical Centers | Comparison of homeless-tailored primary care (H-PACT) and mainstream primary care (PACT) Primary Healthcare | Primary Care Quality—Homeless (PCQ-H) Survey | H-PACTs outscored mainstream PACTs on all scales (all p < 0.001). Unfavourable care experiences were more common in mainstream PACTs compared to H-PACTs, with adjusted risk differences of 11.9% (95% CI = 6.3–17.4), 12.6% (6.2–19.1), 11.7% (6.0–17.3), and 12.6% (6.2–19.1) for Relationship, Cooperation, Access/Coordination, and Homeless-Specific Needs, respectively. For the Relationship and Cooperation scales, H-PACTs were associated with a greater reduction in unfavourable experience for patients with ≥ 2 vulnerabilities versus ≤ 1 (interaction p < 0.0001) |
Vellozzi-Averhoff, 2021 [32] US | Disparities in communication among the inpatient homeless population at a safety-net hospital | To determine whether the homeless population experiences disparities in care and communication during inpatient hospitalisations in a safety-net hospital | PEH n = 33 Non-homeless n = 79 University affiliated urban safety-net hospital | Hospital-Based Care | Modified Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey | Homeless participants trended toward poorer ratings for all HCAHPS subscales, however Differences between PHQ-2 positive scores between the two cohorts did not reach significance |