VA Homeless Programs
Homeless Patient Aligned Care Teams (H-PACT)
Homeless Patient Aligned Care Teams (H-PACT)
H-PACT is a multi-disciplinary, population-based medical home model organized around the unique challenges homeless Veterans face accessing and engaging in care. The H-PACT addresses the multiple medical and social needs of these Veterans in one setting by incorporating 5 core elements that distinguish it from traditional primary care models:
- Reducing barriers to receiving care: H-PACTs provide open-access, walk-in care as well as outreach to the community to engage those Veterans disconnected from VA services;
- Providing one-stop, wrap around services that are integrated and coordinated. Mental health, homeless programs, and primary care staff are co-located to create a continuum of care and an integrated care team. Most H-PACTs also provide food and clothing assistance, hygiene items, showers, and laundry facilities and other services on-site to meet the full continuum of Veteran needs;
- Engaging Veterans in intensive case management that is coordinated with community agencies for continuous care;
- Providing high-quality, evidence-based and culturally sensitive carethrough on-going homeless care skill development for H-PACT staff;
- Being performance-based and accountablewith real-time data and predictive analytic applications to assist teams in targeting those most in-need, provide on-going technical assistance and personalized feedback to the field and inform team performance.
H-PACT enrollment is associated with lower rates of emergency department use and hospitalizations
- Six-month patterns of acute-care use pre-enrollment and post-enrollment for 3,543 consecutively enrolled patients showed a 19.0% reduction in emergency department use and a 34.7% reduction in hospitalizations. (O'Toole, et al. Prev Chronic Dis. 2016 Mar 31;13:E44)
- In a national case-control study, the monthly mean number of emergency encounters for all H-PACT enrollees decreased from 0.26 to 0.19 from the six months before enrollment to the six months after enrollment (p < 0.001). This decrease was most pronounced among H-PACT enrollees with 2+ emergency department visits in the baseline period. (VA HSR&D study SDR 11- 230, "Aligning Resources to Care for Homeless Veterans").
- In a prospective, single blinded, multi-center trial, homeless Veterans in H-PACTs were hospitalized less often than those in PACTs (23.1% vs. 35.4%; p=0.04) (HSR&D SDR 11-230)
H-PACTs are more effective at engaging homeless Veterans in ambulatory care services
- H-PACT-enrolled Veterans averaged 3-5 primary care visits/year (VSSC Homeless Dashboard)
- They also received more social work support than in a PACT, averaging 4.6 visits per year compared with 2.7 visits/year (p<0.01) (HSR&D SDR 11-230)
- They average almost 2 specialty visits/year and over 80% are actively engaged in mental health care and over 90% are enrolled in a VA homeless program (VSSC Homeless Dashboard)
Care in an H-PACT costs almost $10,000 less per Veteran per year
- In a single-blinded, multicenter prospective comparison study, the average H-PACT patient cost$9,379/year less to care for compared to a homeless Veteran enrolled in a PACT, driven largely by fewer hospitalization in VA and the community (HSR&D SDR 11-230)
Intensive outpatient engagement in H-PACTs was associated with significant reductions in emergency department use and identification of undiagnosed conditions
- Homeless Veterans newly enrolled in an H-PACT who received high intensity outpatient primary and specialty care were significantly less likely to use an emergency department compared to a matched control group (O'Toole et al. Am J Public Health, 2013)
Veterans enrolled in H-PACTs were housed faster and at higher rates
- Veterans enrolled in H-PACT gained housing 81.1 days faster than those not enrolled in an H-PACT (HSR&D IIR 07-184 Engaging homeless Veterans in primary care)
H-PACT Fact Sheet
H-PACT Program Brief
Establishing a pharmacist-managed outreach clinic at a day shelter for homeless veterans. Haake ER, Krieger KJ.Haake ER, et al. Ment Health Clin. 2020 Jul 2;10(4):232-236. doi: 10.9740/mhc.2020.07.232
Providing Positive Primary Care Experiences for Homeless Veterans Through Tailored Medical Homes: The Veterans Health Administration's Homeless Patient Aligned Care Teams. Jones AL, Hausmann LRM, Kertesz SG, Suo Y, Cashy JP, Mor MK, Pettey WBP, Schaefer JH Jr, Gordon AJ, Gundlapalli AV., Med Care. 2019 Apr;57(4):270-278. doi: 10.1097/MLR.0000000000001070.
Dual Use and Hospital Admissions among Veterans Enrolled in the VA's Homeless Patient Aligned Care Team. Trivedi AN, Jiang L, Johnson EE, Lima JC, Flores M, O'Toole TP., Health Serv Res. 2018 Dec;53 Suppl 3:5219-5237. doi: 10.1111/1475-6773.13034. Epub 2018 Aug 27.
Population-Tailored Care for Homeless Veterans and Acute Care Use, Cost, and Satisfaction: A Prospective Quasi-Experimental Trial. O'Toole TP, Johnson EE, Borgia M, Noack A, Yoon J, Gehlert E, Lo J. Prev Chronic Dis. 2018 Feb 15;15:E23. doi: 10.5888/pcd15.170311.
Patient-aligned Care Team Engagement to Connect Veterans Experiencing Homelessness With Appropriate Health Care. Gundlapalli AV, Redd A, Bolton D, Vanneman ME, Carter ME, Johnson E, Samore MH, Fargo JD, O'Toole TP. Med Care. 2017 Sep;55 Suppl 9 Suppl 2:S104-S110. doi: 10.1097/MLR.0000000000000770.
Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration's "Homeless Patient Aligned Care Team" Program. O'Toole TP, Johnson EE, Aiello R, Kane V, Pape L., Prev Chronic Dis. 2016 Mar 31;13:E44. doi: 10.5888/pcd13.150567.
Understanding the health of veterans who are homeless: A review of the literature.Weber J, Lee RC, Martsolf D. Public Health Nurs. 2017 Sep;34(5):505-511. doi: 10.1111/phn.12338. Epub 2017 Jul 4. Review.
A national evaluation of homeless and nonhomeless veterans' experiences with primary care. Jones AL, Hausmann LRM, Haas GL, Mor MK, Cashy JP, Schaefer JH, Gordon AJ.
Psychol Serv. 2017 May;14(2):174-183. doi: 10.1037/ser0000116.
No available resources
Jillian Weber, RN
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