Vulnerable population the homeless vetrans

The effects of PTSD that have been especially evident on our returning troops has begun a national conversation about the access to care for the vulnerable veteran population.

Vulnerable population the homeless vetrans

Abstract Introduction Although the clinical consequences of homelessness are well described, less is known about the role for health care systems in improving clinical and social outcomes for the homeless. Methods We conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14, patients.

We correlated site-specific health care performance data for the 3, homeless veterans enrolled in the program from October through Marchincluding those receiving ambulatory or acute health care services during the 6 months prior to enrollment in our study and 6 months post-enrollment with corresponding survey data on the Homeless Patient Aligned Care Team H-PACT program implementation.

We defined high performance as high rates of ambulatory care and reduced use of acute care services. Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3, consecutively enrolled patients showed a Three features were significantly associated with high performance: Conclusion Top Introduction Inthe Institute of Medicine described homeless-related health problems as 3-pronged: Homeless people have a 3.

Homeless people also use high levels of health care, often in costly acute-care settings. In this same survey of the homeless, 1 in 4 had been hospitalized in the previous year Not surprisingly, the more unstable the sheltering arrangement eg, unsheltered street homeless, emergency sheltered homelessthe more likely a homeless person was to use an ED for health care Homeless people face multiple barriers to health care, including transportation, limited availability and fragmentation of health care services, difficulty scheduling and keeping appointments, perceived or actual stigma of homelessness, lack of trust, social isolation, and competing sustenance needs 13— Homeless people frequently have multiple acute health care needs, creating a triaging dilemma that can preclude Vulnerable population the homeless vetrans root-cause needs related to their homeless state eg, exposure to violence, trauma, or the elements; untreated or undertreated physical or mental health conditions.

Aligning and coordinating the resources needed to care for homeless people is difficult in traditional health care settings. For homeless people and for other socially disadvantaged populations, effective health care often lies outside the confines of a strictly medical approach 1 and includes broader social determinants of health, such as housing, income, and family supports.

The medical home is a proactive, primary care-based, interdisciplinary team model constructed on the principles of patient centeredness, a team-based, whole-person orientation to longitudinal care, and active communication and coordination among providers.

This model is considered effective for patients with complex health care needs. We describe the development and implementation of the model over 4 years and present a pre-enrollment—post-enrollment analysis of health care use by homeless veterans participating in this model program.

The intent was to integrate and coordinate health and social services care for homeless veterans with a focus on the highest-risk, highest-need veterans unable or unwilling to access traditional health care. The model draws heavily from lessons learned from the Health Care for the Homeless program funded by the US Department of Health and Human Services 17the theoretic framework of the Behavioral Model for Vulnerable Populations 18and homeless adaptations of both the chronic care model 19 and the ambulatory intensive care model As homeless veterans stabilize clinically and socially, as evidenced by their moving into permanent housing and demonstrating appropriate self-care and health-seeking behaviors, they are transitioned to traditional care settings to continue their care.

Homeless-patient aligned care team model for treatment engagement. In addition, sustenance needs eg, food or food vouchers, hygiene kits, clothes, bus passes, other transportation assistance are available at the same location; 3 intensive health care management that is integrated with community agencies with an emphasis on ongoing, continuous care; 4 ongoing staff training and development of homeless care skills; and 5 data-driven, accountable care processes.

Vulnerable Veterans: PTSD’s Rising Toll on Our Troops – SICK: Healthcare in the Modern Era

Implementation fidelity among sites is addressed in 2 ways. Second, H-PACTs are asked to complete an annual survey querying how core elements are being carried out in their day-to-day practice.

Monthly site-specific reports are provided to each team and consist of the following monitored performance measures across key indicators: This cut-off date was selected to correlate with the annual survey data submitted by each clinic.

Health services use was identified through administrative records capturing clinical encounter data for each care visit for VA-specific types of health care use primary care provider or other health care team members, specialty care visits, mental health, homeless programming [eg, case manager visits, placements in VHA-supported housing programs], acute care hospitalizations, and ED visits and averaged over 12 months for people continuously enrolled during that time.

Because of the high numbers of administrative records on clinical encounters associated with mental health visits and homeless program participation, we examined only the proportion of patients receiving those services post-enrollment.

Also, non-VHA—based care was not considered in this analysis.

Vulnerable population the homeless vetrans

Analyses of pre-enrollment and post-enrollment use of health services were limited to VA-based inpatient hospitalizations and ED visits during the 6 months before enrollment in the H-PACT and the 6 months after enrollment. To provide historic context to our findings, we chose this period to be consistent with previous studies of homeless health services that used this timeframe.

We included all veterans who enrolled in an H-PACT from October through Marchcapturing data on their 6 month pre-enrollment use beginning in May for October enrollees and their 6 month post-enrollment use ending in August for March enrollees.

The stratification was limited to well-established H-PACT teams at the 33 sites studied, which had been in operation for at least 18 months and had at least patients enrolled to minimize potential biases associated with start-up or extremely small enrollments.

We used results from the clinic surveys to define characteristics and care elements of stratified sites: Statistical analyses We conducted a 2-sample proportions analysis of low-performing and high-performing H-PACTs, comparing the proportion of stratified clinics with each care element described previously.

Homeless veterans in the United States - Wikipedia

Included in this analysis were subelements specific to a particular service or offering. The H-PACT program was launched in with 32 sites and expanded to 58 medical facilities and approximately 18, patients by The demographic and ambulatory care use data used in this analysis were for the August enrollment of 14, patients with corresponding characteristics of 33 established H-PACTs.

The pre-enrollment and post-enrollment acute care use data were the aggregated clinical data of 3, veterans enrolled in an H-PACT program from October through March, Top Results The average age of participants was Their DCG-Index complexity score was 0.

These findings contrast with those for the overall population enrolled in primary care at VHA at the time:A Vulnerable Population the Homeless Veterans Patricia Dilbert NUR/ April 7, Deanna Radford, MSN, RN, CNE A Vulnerable Population the homeless Veterans.

 A Vulnerable Population the Homeless Veterans Patricia Dilbert NUR/ April 7, Deanna Radford, MSN, RN, CNE A Vulnerable Population the homeless Veterans In this presentation, we will explore a vulnerable population with the focus on the homeless veterans.

According to Mckinney Act”() A homeless person is one who lacks a fixed, regular and adequate nighttime residence. The overall count in showed 62, homeless veterans in the United States.

In January , there were an estimated 57, homeless veterans in the U.S., or 12% of the homeless population.

Vulnerable population the homeless vetrans

[13] Just under 8% were female. [14]. The authors describe the transition from military to civilian life among the most recent veterans as one of these vulnerable times when a veteran might feel a higher sense of isolation and burden.

Research has documented the significant disease burden among the homeless population (2,3); one community-based survey found that 66% of the homeless had a chronic medical problem, and 33% had 2 or more mental health problems (4).

A Vulnerable Population the Homeless Veterans Patricia Dilbert NUR/ April 7, Deanna Radford, MSN, RN, CNE A Vulnerable Population the homeless Veterans In this presentation, we will explore a vulnerable population with the focus on the homeless veterans.

Vulnerable Population: Veterans by Cameron Adams on Prezi