Table 3. Health Services Use and Costs of US Department of Veterans Affairs’ H-PACT and PACT, Study on Population-Tailored Care for Homeless Veterans and Acute Care Use, Cost, and Satisfaction, June 2012–January 2014.
| Variable | H-PACTa (N = 183) | PACTb (N = 83) | P Valuec |
|---|---|---|---|
| No. of visits, mean (SD) | |||
| Primary care provider and nursing visits | 8.8 (7.1) | 7.1 (6.4) | .06 |
| Primary care provider-specific visits | 5.1 (4.1) | 3.6 (2.8) | .001 |
| Specialty care visits | 3.1 (5.0) | 3.6 (4.5) | .41 |
| Social work visits | 4.6 (3.7) | 2.7 (2.1) | .001 |
| Mental health care visits | 8.8 (11.8) | 13.4 (14.3) | .01 |
| All emergency department visits | 2.6 (4.4) | 2.9 (3.9) | .57 |
| Emergency department visits for ambulatory-care–sensitive conditions | 0 (0.2) | 0.2 (0.6) | .04 |
| No. of hospitalizations, mean (SD) | |||
| Hospitalizations (acute medical/surgical, mental health, and substance abuse) | 0.4 (0.8) | 0.6 (1.2) | .06 |
| Hospitalizations not at a VA Hospital | 0 (0.1) | 0.1 (9.7) | .29 |
| 30-Day prescription drug fills, mean (SD) | 40.5 (39.5) | 58.8 (53.9) | .001 |
| No. (%) of participants accessing . . . | |||
| Psychiatry | 102 (56.0) | 52 (63.4) | .26 |
| Psychology | 59 (32.4) | 32 (39.0) | .30 |
| Group therapy | 73 (40.1) | 44 (53.7) | .04 |
| Emergency department (any) | 111 (61.0) | 54 (65.9) | .45 |
| Emergency department (mental health–related) | 62 (34.1) | 39 (47.6) | .04 |
| Hospitalization | 42 (23.1) | 29 (35.4) | .04 |
| Costs, mean (SD), $ | |||
| Overall | 28,036 (27,036) | 37,415 (36,872) | .04 |
| Primary care | 2,947 (2,511) | 2,266 (2,266) | .03 |
| Specialty care | 1,824 (3,838) | 1,880 (3,131) | .90 |
| Mental health-substance abuse treatment | 3,378 (4,759) | 4,770 (5,084) | .03 |
| Emergency department (all) | 1,978 (3,627) | 2,235 (4,076) | .61 |
| Emergency department for ambulatory care–sensitive conditions | 19 (165) | 105 (517) | .14 |
| Non-VA based care | 19 (252) | 1,035 (8,298) | .27 |
| Hospitalization | 5,530 (18,138) | 10,429 (24,427) | .10 |
| Prescription drugs | 1,698 (2,441) | 3,181 (11,483) | .25 |
Abbreviations: H-PACT, Homeless-Patient Aligned Care Team; PACT, Patient Aligned Care Team; SD, standard deviation; VA, US Department of Veterans Affairs.
a
Built on the framework of PACT, H-PACT addresses issues of access, treatment engagement, competing priorities, and the social determinants of health that are associated with homelessness.
b
PACT is a primary care–based model constructed on the principles of patient centeredness, interdisciplinary teamwork, efficiency, comprehensive whole-person–oriented longitudinal care, and active communication and coordination (24).
c
Determined by t test (difference in means) and χ2 analyses (difference in frequencies).