Comparison of primary care experiences and outpatient health service utilization among black and latino homeless-experienced veterans: An analysis of patient-centered medical homes

OBJECTIVES: To examine whether, among persons with recent homeless experience, minoritized clients rate primary care differently from non-minoritized clients in Veterans Affairs (VA) mainstream and homeless tailored clinics, through the largest survey of homeless-experienced Black, White, and Latino Veterans to date. 

METHODS: Surveys were collected from HEVs in Homeless-tailored Patient-Aligned Care Teams (HPACTs) and mainstream Patient Aligned Care Teams (PACTs; n = 4894). We tested multivariable associations between race/ethnicity, clinic (HPACT vs mainstream-PACT), and their interaction, on care experience ratings and service utilization. 

RESULTS: There were no major differences in care ratings by race/ethnicity; medical and social vulnerability factors were associated with worse ratings. Black HEVs rated team Cooperation and Access/Coordination modestly better compared to White HEVs, while being Latino was nonsignificant. HPACTs were rated higher than mainstream-PACTs. Better Access/Coordination ratings were associated with more primary care (+1.12 additional visits per point increase) and mental health outpatient visits (+4.37 additional visits per point increase). 

CONCLUSIONS: In VA primary care, homeless-tailored clinics outperformed mainstream ones while racial/ethnic differences in ratings were minor. Optimizing perceived Access/Coordination of services may offer a path to increased service use.