American journal of public health · 2013
Comparing homeless persons' care experiences in tailored versus nontailored primary care programs.
СтатьяПоддержка NIH: внешняя программаПоддержка правительства СШАНазвание и аннотация: Перевод в очереди
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Kertesz Stefan G, Holt Cheryl L, Steward Jocelyn L, Jones Richard N, Roth David L, Stringfellow Erin, Gordon Adam J, Kim Theresa W, Austin Erika L, Henry Stephen Randal, Kay Johnson N, Shanette Granstaff U, O'Connell James J, Golden Joya F, Young Alexander S, Davis Lori L, Pollio David E
Аннотация
OBJECTIVES: We compared homeless patients' experiences of care in health care organizations that differed in their degree of primary care design service tailoring.
METHODS: We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients.
RESULTS: Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient-clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient-clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results.
CONCLUSIONS: Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.
METHODS: We surveyed homeless-experienced patients (either recently or currently homeless) at 3 Veterans Affairs (VA) mainstream primary care settings in Pennsylvania and Alabama, a homeless-tailored VA clinic in California, and a highly tailored non-VA Health Care for the Homeless Program in Massachusetts (January 2011-March 2012). We developed a survey, the "Primary Care Quality-Homeless Survey," to reflect the concerns and aspirations of homeless patients.
RESULTS: Mean scores at the tailored non-VA site were superior to those from the 3 mainstream VA sites (P < .001). Adjusting for patient characteristics, these differences remained significant for subscales assessing the patient-clinician relationship (P < .001) and perceptions of cooperation among providers (P = .004). There were 1.5- to 3-fold increased odds of an unfavorable experience in the domains of the patient-clinician relationship, cooperation, and access or coordination for the mainstream VA sites compared with the tailored non-VA site; the tailored VA site attained intermediate results.
CONCLUSIONS: Tailored primary care service design was associated with a superior service experience for patients who experienced homelessness.