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"Walking in a maze": community providers' difficulties coordinating health care for homeless patients.
BMC Health Serv Res. 2016 09 07; 16:480.BH

Abstract

BACKGROUND

While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population.

METHODS

Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used.

RESULTS

HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received.

CONCLUSIONS

Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons.

Links

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Authors+Show Affiliations

LaCoursiere Zucchero T
Graduate School of Nursing, University of Massachusetts Medical School, 55 Lake Avenue North, Worcester, MA, 01655, USA. Terri.Zucchero@umassmed.edu. Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA. Terri.Zucchero@umassmed.edu.
McDannold S
Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA. Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.
McInnes DK
Center for Healthcare Organization and Implementation Research (CHOIR), Edith Nourse Rogers Memorial Veterans Hospital, 200 Springs Road, Bedford, MA, 01730, USA. Department of Health Law, Policy, and Management, Boston University School of Public Health, 715 Albany Street, Boston, MA, 02118, USA.

MeSH

CommunicationContinuity of Patient CareDelivery of Health CareFemaleHealth ServicesIll-Housed PersonsHumansMalePatient Protection and Affordable Care ActQualitative ResearchUnited StatesUnited States Department of Veterans AffairsVeterans

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27604833

Citation

LaCoursiere Zucchero, Terri, et al. ""Walking in a Maze": Community Providers' Difficulties Coordinating Health Care for Homeless Patients." BMC Health Services Research, vol. 16, 2016, p. 480.
LaCoursiere Zucchero T, McDannold S, McInnes DK. "Walking in a maze": community providers' difficulties coordinating health care for homeless patients. BMC Health Serv Res. 2016;16:480.
LaCoursiere Zucchero, T., McDannold, S., & McInnes, D. K. (2016). "Walking in a maze": community providers' difficulties coordinating health care for homeless patients. BMC Health Services Research, 16, 480. https://doi.org/10.1186/s12913-016-1722-x
LaCoursiere Zucchero T, McDannold S, McInnes DK. "Walking in a Maze": Community Providers' Difficulties Coordinating Health Care for Homeless Patients. BMC Health Serv Res. 2016 09 7;16:480. PubMed PMID: 27604833.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - "Walking in a maze": community providers' difficulties coordinating health care for homeless patients. AU - LaCoursiere Zucchero,Terri, AU - McDannold,Sarah, AU - McInnes,D Keith, Y1 - 2016/09/07/ PY - 2016/02/09/received PY - 2016/08/26/accepted PY - 2016/9/9/entrez PY - 2016/9/9/pubmed PY - 2017/11/29/medline KW - Care coordination KW - Homelessness KW - Veterans SP - 480 EP - 480 JF - BMC health services research JO - BMC Health Serv Res VL - 16 N2 - BACKGROUND: While dual usage of US Department of Veterans Affairs (VA) and non-VA health services increases access to care and choice for veterans, it is also associated with a number of negative consequences including increased morbidity and mortality. Veterans with multiple health conditions, such as the homeless, may be particularly susceptible to the adverse effects of dual use. Homeless veteran dual use is an understudied yet timely topic given the Patient Protection and Affordable Care Act and Veterans Choice Act of 2014, both of which may increase non-VA care for this population. The study purpose was to evaluate homeless veteran dual use of VA and non-VA health care by describing the experiences, perspectives, and recommendations of community providers who care for the population. METHODS: Three semi-structured focus group interviews were conducted with medical, dental, and behavioral health providers at a large, urban Health Care for the Homeless (HCH) program. Qualitative content analysis procedures were used. RESULTS: HCH providers experienced challenges coordinating care with VA medical centers for their veteran patients. Participants lacked knowledge about the VA health care system and were unable to help their patients navigate it. The HCH and VA medical centers lacked clear lines of communication. Providers could not access the VA medical records of their patients and felt this hampered the quality and efficiency of care veterans received. CONCLUSIONS: Substantial challenges exist in coordinating care for homeless veteran dual users. Our findings suggest recommendations related to education, communication, access to electronic medical records, and collaborative partnerships. Without dedicated effort to improve coordination, dual use is likely to exacerbate the fragmented care that is the norm for many homeless persons. SN - 1472-6963 UR - https://www.unboundmedicine.com/medline/citation/27604833/"Walking_in_a_maze":_community_providers'_difficulties_coordinating_health_care_for_homeless_patients_ DB - PRIME DP - Unbound Medicine ER -