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Homeless Veterans Patient Aligned Care Team
содержание презентации «Homeless Veterans Patient Aligned Care Team.ppt»| Сл | Текст | Сл | Текст |
| 1 | Homeless Veterans Patient Aligned Care | 9 | mental health, and substance abuse |
| Team (H-PACT). Office of Homeless Programs | treatment. Ending Veteran homelessness | ||
| Office of Primary Care Operations. | Housing placement/stabilization – | ||
| December 2012. | Integrate clinical care with housing | ||
| 2 | Background. Homeless Veterans have | objectives; partner with housing staff and | |
| more chronic medical, mental health and | community agencies. | ||
| substance abuse needs that are more | 10 | H-PACT Model for Treatment Engagement | |
| difficult to treat in traditional care | of Homeless Veteran | ||
| models and to coordinate within fragmented | Disengaged/Disenfranchised from Care ? | ||
| delivery systems. Transportation and | Treatment Engagement ? Stabilization | ||
| scheduling challenges, competing | Unstable sheltering Housing First Chronic | ||
| priorities, and services not aligned with | disease management Significant barriers to | ||
| their needs keep many homeless Veterans | treatment engagement Facilitated | ||
| from accessing primary care and receiving | access/population tailored care Prevent | ||
| services necessary to exit homelessness. | recidivism Health Care low among Maslow | ||
| Homeless Veterans end up relying on | Hierarchy of needs Care management of | ||
| emergency departments for care and are | conditions Early identification new needs | ||
| hospitalized at much higher rates than | High rates of ED and inpatient care | ||
| their housed counterparts. Homeless | Leading to homelessness Premature | ||
| Veterans are three to six times more | morbidity/mortality Perpetuating | ||
| likely to become ill than housed people | homelessness Delayed and deferred because | ||
| and cost three times more to care for than | of homelessness Address competing needs. | ||
| non-homeless Veterans. | Intervention. Disposition. Identification | ||
| 3 | Background. Integrated Primary | and Referral. Homeless PACT Enhanced, open | |
| Care-Homeless Services care models | access Intensive case management Care | ||
| tailored to the needs and specific | tailored to population | ||
| challenges of homeless Veterans have been | needs/de-stigmatizing care One-stop care – | ||
| able to: Reduce emergency department use | On-site addressing of competing sustenance | ||
| by up to 40% Reduce hospitalizations by | needs. Homeless situation stabilized; | ||
| 30-50% Improve chronic disease management | transferred to general population PACT | ||
| outcomes Expedite housing placement and | team w/ specialty care access. Emergency | ||
| retention. | Departments. Inpatient Wards. Community | ||
| 4 | The Need for a Paradigm Shift. How do | outreach/ Agency referrals. Homeless | |
| we take advantage of health care seeking | situation stabilized; transferred to | ||
| behavior and the “treatable moment” | Special Population PACT based on patient | ||
| embedded in a health care episode? How can | need: SMI PACT Women’s Health PACT HIV | ||
| the resources and “safe haven” of the | PACT. Homeless situation not stabilized: | ||
| health care setting be used to break the | Patient stays in Homeless PACT due to | ||
| cycle of homelessness and poor health? | ongoing homelessness, imminent risk of | ||
| 5 | Homeless Patient Aligned Care Team. | return to homelessness. | |
| Program goal is creating a collaborative | 11 | H-PACT Program. Implementation Update | |
| Homeless Programs-Primary Care model that | 37 sites funded to develop H-PACTs 19 | ||
| eliminates barriers to quality health care | VISNs, 24 states, 20 in high impact/high | ||
| and improves health and housing outcomes | volume cities, 7 in rural communities | ||
| of Veterans that are homeless or at | Active engagement from Primary Care, | ||
| imminent risk of homelessness. Not | Homeless and Mental Health programs. | ||
| intended to replace care being provided or | 12 | Data Snapshot. 30 H-PACT sites are | |
| alter ongoing care relationships for those | actively seeing homeless Veterans. Over | ||
| homeless Veterans engaged in treatment | 4000 patients enrolled to date. | ||
| models (e.g. Severe Mental Illness (SMI), | Anticipated approximately 10,000 will be | ||
| HIV care). | enrolled by end of FY 2013. H-PACT | ||
| 6 | H-PACT Model. Three different | enrollment increasing by approximately 400 | |
| homeless-oriented primary care PACT models | Veterans per month. Most Veterans will | ||
| will be supported by this initiative for | stay in the H-PACT 12 to 18 months, | ||
| local station implementation. Model | depending on individual circumstances, | ||
| adoption will be based on site-specific | preferences. 21 August 2015. | ||
| need, capacity, geography and targeted | 13 | VISN. Station. VISN. Station. VISN. | |
| focus: Co-located, integrated Homeless | Station. VISN. Station. 1. Providence | ||
| PACT. PACT team enhanced with homeless | VAMC. 4. Philadelphia VAMC. 10. Chalmers | ||
| case management. Community Resource and | P. Wylie VAMC (Columbus). 20. VA Puget | ||
| Referral Center (CRRC)-based Homeless | Sound HCS (Seattle). 1. VA Connecticut | ||
| outreach/PACT. | Healthcare System (West Haven). 4. VA | ||
| 7 | Health and Homelessness. Housing | Pittsburgh HCS. 11. Battle Creek VAMC. 20. | |
| Security for Homeless Persons. Health Care | Portland VAMC. 1. VA Maine HCS (Togus). 5. | ||
| sites as “First Stops” for newly homeless. | VA Maryland HCS (Baltimore). 11. John D. | ||
| The health encounter as a “treatable | Dingell VAMC (Detroit). 21. VA Northern | ||
| moment” for behavior change and treatment | California HCS. 1. VA Boston HCS (Causeway | ||
| engagement. Health maintenance and support | Street CBOC). 5. Washington DC VAMC. 12. | ||
| as a means of keeping people in housing. | Jesse Brown VAMC (Chicago). 21. VA Pacific | ||
| 8 | H-PACT Program. H-PACT’s must be able | Islands HCS (Honolulu). 1. Leeds VA | |
| to: Provide Accessible, Just-in-Time | Primary Care Center (New Bedford). 6. | ||
| Continuity Care to homeless Veterans when | Hampton VAMC. 16. Micheal E. DeBakey VAMC | ||
| and where they need it. Respond to the | (Houston). 21. San Francisco VAMC. 2. | ||
| “Treatable Moment” with staff trained and | Canandiagua VAMC. 7. Ralph H. Johnson VAMC | ||
| prepared to engage patients in behavior | (Charleston). 16. Southeast Louisiana | ||
| change, and with resources in place to act | Veterans HCS (New Orleans). 22. VA San | ||
| on patient motivation. Create a care | Diego HCS. 3. Northport VAMC. 7. | ||
| setting that promotes trust and | Birmingham VAMC. 17. South Texas Veterans | ||
| relationship building necessary for | HCS (San Antonio). 22. VA Greater Los | ||
| longitudinal primary care and care | Angeles HCS. 3. James J. Peters VAMC | ||
| coordination. Address competing social and | (Bronx). 8. James A. Haley VAMC (Tampa). | ||
| sustenance needs of the Veteran trying to | 18. Phoenix VA HCS. 22. VA Southern Nevada | ||
| access health services. Employ a Rapid | HCS. 3. VA Hudson Valley HCS (Montrose). | ||
| Engagement/Housing-First approach. | 9. Lexington VAMC. 19. VA Eastern Colorado | ||
| 9 | H-PACT Goals. Deliverables: Systems | HCS (Denver). 23. Minneapolis VA HCS. . | |
| redesign – Population-Centered Homeless | . . . . . 23. Iowa City VA HCS. 13. | ||
| PACTs: Rapid Access – Reduce barriers and | 14 | Anticipated outcomes. Reduced | |
| obstacles to receiving care; bring | emergency department visits, hospital | ||
| homeless into care earlier in their | admissions Increased ambulatory care use | ||
| homelessness. Sustained Engagement – | (primary care, specialty, mental health, | ||
| Provide ongoing, longitudinal care that | addictions) Expedited housing/reduced | ||
| responds to changing needs, interests and | recidivism Improved chronic disease | ||
| readiness of the Veteran. Improved | monitoring/management Enhanced care, | ||
| Clinical Outcomes for multi-morbid | cost-efficiencies. 21 August 2015. | ||
| homeless Veterans Improved Quality of Life | 15 | H-PACT and Community Partners. | |
| – Provide comprehensive chronic disease | Referral source Development of | ||
| and preventive care to a traditionally | partnerships Collaborative effort to serve | ||
| disenfranchised group Greater Efficiencies | homeless Veterans. 15. | ||
| in our care delivery system Care Offsets – | 16 | Questions? For more information please | |
| Reduce emergency department and hospital | contact: Rico Aiello, H-PACT Project | ||
| use; increase primary care, outpatient | Coordinator Riccardo.aiello@va.gov. 16. | ||
| Homeless Veterans Patient Aligned Care Team.ppt | |||
Homeless Veterans Patient Aligned Care Team
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