Meeting Patients Where They Are: Evaluating a Student-Run, Shelter-Based Model for Connecting Homeless  Patients with a Medical Home

Aaron Matthew Brug; Georgiana Green; Scott I. Mayer; Maren Gregersen; Joseph Kanter; Catherine E. Jones

doi:10.59586/jsrc.v6i1.139

Aaron M Brug, MD Tulane University School of Medicine
Georgiana Green, MD, MPH Tulane University School of Medicine
Scott Mayer, MD, MA Tulane University School of Medicine
Maren Gregersen Tulane University School of Medicine
Joseph Kanter, MD, MPH Tulane University School of Medicine
Catherine E Jones, MD Tulane University School of Medicine

DOI: https://doi.org/10.59586/jsrc.v6i1.139

Keywords: medical home, primary care, mental health, homelessness, student-run clinic, homeless shelter

Abstract

Background: Substantial barriers exist between persons experiencing homelessness and the health care system, which contributes to significant health disparities. Innovations to connect patients to long-term primary care via the â€˜medical homeâ€™ model have had mixed results. This study evaluates the effectiveness of an innovative, student-run, shelter-based clinic model that leverages its onsite location to link patients to a medical home.

Methods: A retrospective chart review of patient visits at two shelter-based, student-run clinics between October 1, 2016 and October 1, 2017 was performed. Data collected included demographics, health risk factors, medical histories, and visit chief concerns. Patients referred to a medical home were assessed for successful follow-up at that location within 90 days. Successful medical home follow-up attendance was modeled using multivariable logistic regression with backwards elimination and a significance threshold of p<0.05.

Results: Within 90 days of referral, 30% of all patients referred to the medical home successfully attended a follow-up appointment, with 57% of new patients attending more than one appointment in the same time interval. Among patients who received referrals, those with a mental health related chief complaint were significantly more likely to follow-up at a medical home than those with other chief complaints (p=0.024). Medicaid insurance status negatively predicted successful follow-up (p=0.041).

Conclusions: Student-run free clinics in locations that access vulnerable populations can be effectively used to link patients to medical homes. A better understanding of these factors may provide insight into how to help patients access a medical home and establish longitudinal care.