Abstract
PURPOSEHigh-quality, comprehensive care of vulnerable populations requires interprofessional ambulatory care teams skilled in addressing complex social, medical, and psychological needs. Training health professionals in interprofessional settings is crucial for building a competent future workforce. The impacts on care utilization of adding continuity trainees to ambulatory teams serving vulnerable populations have not been described. We aim to understand how the addition of interprofessional trainees to an ambulatory clinic caring for Veterans experiencing homelessness impacts medical and mental health services utilization.METHODSTrainees from five professions were incorporated into an interprofessional ambulatory clinic for Veterans experiencing homelessness starting in July 2016. We performed clinic-level interrupted time series (ITS) analyses of pre- and post-intervention utilization measures among patients enrolled in this training continuity clinic, compared to three similar VA homeless clinics without training programs from October 2015 to September 2018.RESULTSOur sample consisted of 37,671 patient- months. There was no significant difference between the intervention and comparison groups’ post-intervention slopes for numbers of primary care visits (difference in slopes =−0.16 visits/100 patients/month; 95% CI −0.40, 0.08; p=0.19), emergency department visits (difference in slopes = 0.08 visits/100 patients/month; 95% CI −0.16, 0.32; p=0.50), mental health visits (difference in slopes = −1.37 visits/month; 95% CI −2.95, 0.20; p= 0.09), and psychiatric hospitalizations (−0.005 admissions/100 patients/month; 95% CI −0.02, 0.01; p= 0.62). We found a clinically insignificant change in medical hospitalizations.CONCLUSIONSAdding continuity trainees from five health professions to an interprofessional ambulatory clinic caring for Veterans experiencing homelessness did not adversely impact inpatient and outpatient care utilization. An organized team-based care approach is beneficial for vulnerable patients and provides a meaningful educational experience for interprofessional trainees by building health professionals’ capabilities to care for vulnerable populations.
Highlights
In 2019, approximately 568,000 people experienced homelessness (PEH) in the USA on any given night, and that number continues to increase.[1]
O’Toole et al found that patients enrolled in the VA homeless patient-aligned care team (HPACT), a population-tailored multidisciplinary primary care clinic, had lower costs of care compared with primary care not targeted to the needs of Veterans experiencing homelessness (VEH)
This study aims to determine if the integration of IP trainees into an ambulatory clinic for VEH impacts medical and mental health care services utilization
Summary
In 2019, approximately 568,000 people experienced homelessness (PEH) in the USA on any given night, and that number continues to increase.[1]. 2 Historically poor access to primary care led to higher use of emergency and hospital care. Since 2009, the Veteran Health Administration’s national homeless program has reduced Veteran homelessness by nearly 50% using a multidisciplinary ambulatory care team approach with Housing First principles. Intensive ambulatory care teams composed of professionals from mental health, social services, and medicine successfully meet the complex needs of PEH.[3] O’Toole et al found that patients enrolled in the VA homeless patient-aligned care team (HPACT), a population-tailored multidisciplinary primary care clinic, had lower costs of care compared with primary care not targeted to the needs of Veterans experiencing homelessness (VEH). HPACT patients had more social work and primary care visits, and fewer emergency department visits, outpatient psychiatry visits, and hospitalizations.[4]
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