| Primary Author: | Linda Caissie, MSN, RN, ACNS-BC |
| Co-Principal Investigators/Collaborators: | N/A |
| Organization | Veterans Healthcare Administration |
Abstract
Purpose
The purpose of this study is to determine if a hospital visit from the Homeless Patient Aligned Care Team (HPACT) RN will increase post discharge contact from the homeless Veteran.
Background
One challenge in working with homeless Veterans is low compliance with medical care. Addressing chronic illness is not a top priority for this vulnerable population who are trying to find shelter or food on a daily basis. This leads increased morbidity and mortality. Homeless Veterans have a mortality rate almost three times greater than Veterans with stable housing. They experience trauma, difficulty managing chronic medical problems, psychiatric illness, and addiction. The medical management of these conditions is often addressed in emergency rooms, instead of the primary care setting. These Veterans often require hospital admission, and have a longer length of stay . To facilitate medical care, the Homeless Patient Aligned Care Team model (HPACT) requires contact after each hospital discharge. Homeless Veterans are not always discharged to a location where they can receive calls.
Materials & Methods
The RN assigned to HPACT will visit the patients prior to hospital discharge to discuss strategies post hospitalization.
Results
Results show 100% compliance to post discharge contact to primary care with homeless Veterans visited by the RN during the hospital stay. The RN is able to engage the Veteran, demonstrate a patient centered care action, and establish a connection with the HPACT that promotes primary care follow up.
Conclusion
The physical presence of an outpatient HPACT Nurse at the bedside of a hospitalized homeless Veteran will promote primary care follow up. With the establishment of this relationship, the Veteran will be motivated to seek regular care in the clinic setting, decreasing ER utilization, improving chronic disease management, and decrease medical admissions/cost.
Bibliography
-
Balshem, H., Christensen, V., & Tuepker, A. (2011). A Critical Review of the Literature Regarding Homelessness among Veterans. Retrieved March 25, 2014, from ...
- Hwang,S., Tolomiczenko, G., Kouyoumdjian, F., & Garner, R. (2005). Interventions to improve the health of the homeless: a systematic review. American Journal of Preventative Medicine, 29(4), 311.e1-311.e9.
- Lachman, V. (2012). Applying the ethics of care to your nursing practice. Medsurg Nursing, 21(2), 112-116.
- O’Toole, T., Conde-Martel, A., Gibbon, J., Hanusa, B., & Fine, M. (2003). Health care of homeless veterans. Journal of General Internal Medicine, 18, 929-933.
- O’Toole, T., Pirraglia, P., Dosa, D., Bourgault, C., Redihan, S., O’Toole, M., et al. (2011). Building care systems to improve access for high-risk and vulnerable veteran populations. Journal of General Internal Medicine, 26, 663-668.
- O’Toole, T., Bourgault, C., Johnson, E., Redihan, S., Borgia, M., Aiello, R., et al. (2013). New to care: demands on a health system when homeless veterans are enrolled in a medical home model.
- American Journal of Public Health, 103(S2), S374-379.
- Tonges, M. & Ray, J. (2011). Translating caring theory into practice: the Carolina care model. The Journal of Nursing Administration, 41(9), 374-381.
- United States Interagency Council on Homelessness. (2013). VA’s HPACT Program Collaborates to Meet Healthcare, Housing Needs. Retrieved March 25, 2014, from United States Department of Health and Human Services and The American Hospital Association. (2012). Implementation Guide to Reduce Avoidable Readmissions. Retrieved March 25,2014, from Watson, J., (2001). Jean Watson: theory of human caring. In M.E. Parker (Ed.), Nursing Theories and Nursing Practice. (343-354). Philadelphia, PA: Davis.
© Improvement Science Research Network, 2012
The ISRN published this as received and with permission from the author(s).