Table 6 Quantitative studies

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