Observational studyPreventing chronic disease2016
Tailoring Care to Vulnerable Populations by Incorporating Social Determinants of Health: the Veterans Health Administration's "Homeless Patient Aligned Care Team" Program.
Observational study in Preventing chronic disease, 2016. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 69 papers, 4 of them syntheses that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
69 citing papers in PubMed, 4 syntheses or guidelines pooled it.
- Collecting and using social needs data in health settings: a systematic review of the literature on health service utilization and costs.BMC health services research · 2025Pooled it
- Systematic Review of Care Coordination Interventions Linking Health and Social Services for High-Utilizing Patient Populations.Population health management · 2022Pooled it
- Impact of Healthcare Delivery System Type on Clinical, Utilization, and Cost Outcomes of Patient-Centered Medical Homes: a Systematic Review.Journal of general internal medicine · 2020Pooled it
- Effectiveness of Intensive Primary Care Interventions: A Systematic Review.Journal of general internal medicine · 2017Pooled it
- Perceptions of Medically Complex Patients Enrolled in an Ambulatory Intensive Care Unit at a Healthcare-for-the-Homeless Clinic.Journal of the American Board of Family Medicine : JABFM · 2025Trial
- Ambulatory Intensive Care for Medically Complex Patients at a Health Care Clinic for Individuals Experiencing Homelessness: The SUMMIT Randomized Clinical Trial.JAMA network open · 2023Trial
- Engaging multilevel stakeholders in an implementation trial of evidence-based quality improvement in VA women's health primary care.Translational behavioral medicine · 2017Trial
- A Hybrid III stepped wedge cluster randomized trial testing an implementation strategy to facilitate the use of an evidence-based practice in VA Homeless Primary Care Treatment Programs.Implementation science : IS · 2017Trial
- Evaluating the impacts of critical time intervention implementation on health service utilization among homeless-experienced veterans: a retrospective observational study.BMC health services research · 2026Observational
- Effects of Social Prescribing for Older Adults: An Evidence and Gap Map.Campbell systematic reviews · 2026Review
- Patient and Primary Care Characteristics Associated with Emergency Department Utilization Among Homeless-Experienced Veterans.Journal of general internal medicine · 2026Article
- Recommended Cardiometabolic Screening Guidelines for Unhoused Adults: A Street Medicine Needs Assessment.Clinics and practice · 2026Article
- Improving access to healthcare services for people experiencing homelessness: evidence from a scoping review of interventions.Health & justice · 2025Review
- Social Determinants of Health ICD-10 Code Use by a Large Integrated Healthcare System.Healthcare (Basel, Switzerland) · 2025Article
- Baseline Housing Stability Positively Impacts the Effect of an Ambulatory Intensive Care Unit on Decreasing Hospitalization Rates.Journal of general internal medicine · 2025Article
- Factors associated with mortality following hospitalization among veterans with opioid use disorder.Journal of substance use and addiction treatment · 2025Article
- A National Mobile Medical Unit (MMU) Program to Address the Healthcare Needs of Veterans Experiencing Homelessness: An Evaluation Protocol.Health services insights · 2025Article
- The Social Risk ACTIONS Framework: Characterizing Responses to Social Risks by Health Care Delivery Organizations.Population health management · 2024Article
- Organizational and patient factors associated with positive primary care experiences for veterans with current or recent homelessness.Health services research · 2024Article
- The Association Between Chronic Pain, Substance use, and Primary Care Experience Among Veterans with Ongoing or Recent Homelessness.Journal of general internal medicine · 2024Article
9 more citing papers are in PubMed but not listed here.
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
5 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
introductionAlthough 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. We described the national implementation of a "homeless medical home" initiative in the Veterans Health Administration (VHA) and correlated patient health outcomes with characteristics of high-performing sites.
methodsWe conducted an observational study of 33 VHA facilities with homeless medical homes and patient- aligned care teams that served more than 14,000 patients. We correlated site-specific health care performance data for the 3,543 homeless veterans enrolled in the program from October 2013 through March 2014, including 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.
resultsMore than 96% of VHA patients enrolled in these programs were concurrently receiving VHA homeless services. Of the 33 sites studied, 82% provided hygiene care (on-site showers, hygiene kits, and laundry), 76% provided transportation, and 55% had an on-site clothes pantry; 42% had a food pantry and provided on-site meals or other food assistance. 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. Three features were significantly associated with high performance: 1) higher staffing ratios than other sites, 1) integration of social supports and social services into clinical care, and 3) outreach to and integration with community agencies.
conclusionIntegrating social determinants of health into clinical care can be effective for high-risk homeless veterans.
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Registered trials
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