Applying the Chronic Care Model to Homeless Veterans: Effect of a Population Approach to Primary Care on Utilization and Clinical Outcomes

Objectives We compared a population tailored approach to primary care for homeless veterans with a usual care approach Methods We conducted a retrospective protective cohort study of homeless veterans enrolled in a population tailored primary care clinic matched to a historical sample in general internal medicine clinics Overall 177 patients were enrolled 79 in the Homeless Oriented Primary Care Clinic and 98 in general internal medicine primary care Results Homeless oriented primary care-enrolled patients had greater improvements in hypertension diabetes and lipid control and primary care use was higher during the first 6 months (5 96 visits per person vs 1 63 for general internal medicine) but stabilized to comparable rates during the second 6 months (2 01 vs 1 31 respectively) Emergency department (ED) use was also higher (2 59 vs 1 89 visits) although with 40% lower odds for nonacute ED visits than for the general internal medicine group (95% confidence interval. 2 0 8) Excluding substance abuse and mental health admissions hospitalizations were reduced among the homeless veterans between the 2 periods (28 6% vs 10 8% P< 01) compared with the general internal medicine group (48 2% vs 44 4% P= 6 difference of differences P< 01) Conclusions Tailoring primary care to homeless veterans can decrease unnecessary ED use and medical admissions and improve chronic disease management (Am J Public Health 2010 100 2493-2499 doi 10 2105/AJPH 2009 179416)