Perceptions of Medically Complex Patients Enrolled in an Ambulatory Intensive Care Unit at a Healthcare-for-the-Homeless Clinic

References

1. 1.↵
   1. Cohen S,
   2. Yu W

   . The concentration and persistence in the level of health expenditures over time: estimates for the U.S. population, 2008–2009. Statistical Brief #354 Agency for Healthcare Research and Quality, Rockville, MD 2012 (Available at: http://www.meps.ahrq.gov/mepsweb/data_files/publications/st354/stat354.shtml).
2. 2.↵
   1. Bodenheimer T

   . Strategies to reduce costs and improve care for high-utilizing Medicaid patients: reflections on pioneering programs. Princeton, JNJ: Center for Health Care Strategies; Accessed Aug 1, 2016 (Available at: http://www.chcs.org/media/HighUtilizerReport_102413_Final3.pdf).
3. 3.↵
   1. Yee T,
   2. Lechner AE,
   3. Carrier E

   . High-intensity primary care: lessons for physician and patient engagement. (National Institute for Health Care Reform Research Brief No 9) Available at: http://wwwnihcrorg/High-Intensity-Primary-Care Accessed Nov 12, 2015.
4. 4.↵
   1. Gawande A

   . The hot spotters: can we lower medical costs by giving the neediest patients better care? New Yorker 2011;40–51. (Available at: http://www.ncbi.nlm.nih.gov/pubmed/21717802).
5. 5.↵
   1. Finkelstein A,
   2. Zhou A,
   3. Taubman S,
   4. Doyle J

   . Health care hotspotting - a randomized, controlled trial. N Engl J Med 2020;382:152–62.

   OpenUrlCrossRefPubMed
6. 6.↵
   1. Zulman DM,
   2. Pal Chee C,
   3. Ezeji-Okoye SC,
   4. et al

   . Effect of an intensive outpatient program to augment primary care for high-need Veterans Affairs patients: a randomized clinical trial. JAMA Intern Med 2017;177:166–75.

   OpenUrlPubMed
7. 7.↵
   1. O'Toole TP,
   2. Johnson EE,
   3. Aiello R,
   4. Kane V,
   5. Pape L

   . Tailoring care to vulnerable populations by incorporating social determinants of health: the Veterans Health Administration's “Homeless Patient Aligned Care Team” Program. Prev Chronic Dis 2016;13:E44.

   OpenUrlPubMed
8. 8.↵
   1. Counsell SR,
   2. Callahan CM,
   3. Clark DO,
   4. et al

   . Geriatric care management for low-income seniors: a randomized controlled trial. Jama 2007;298:2623–33.

   OpenUrlCrossRefPubMedWeb of Science
9. 9.↵
   1. Edwards ST,
   2. Peterson K,
   3. Chan B,
   4. Anderson J,
   5. Helfand M

   . Effectiveness of intensive primary care interventions: a systematic review. J Gen Intern Med 2017;32:1377–86.

   OpenUrlCrossRefPubMed
10. 10.↵
    1. Chan B,
    2. Edwards ST,
    3. Srikanth P,
    4. et al

    . Ambulatory intensive care for medically complex patients at a health care clinic for individuals experiencing homelessness: the SUMMIT randomized clinical trial. JAMA Netw Open 2023;6:e2342012.

    OpenUrlPubMed
11. 11.↵
    1. Lantz PM

    . “Super-utilizer” interventions: what they reveal about evaluation research, wishful thinking, and health equity. Milbank Q 2020;98:31–4.

    OpenUrlCrossRefPubMed
12. 12.↵
    1. Marcotte LM,
    2. Reddy A,
    3. Liao J

    . Addressing avoidable healthcare costs: time to cool off on hotspotting in primary care? J Gen Intern Med 2019;34:2634–6.

    OpenUrlCrossRefPubMed
13. 13.↵
    1. Edwards ST,
    2. Park B

    . Health care hotspotting - a randomized, controlled trial. N Engl J Med 2020;382:2172–3.

    OpenUrlPubMed
14. 14.↵
    1. Jones AL,
    2. Hausmann LRM,
    3. Kertesz SG,
    4. et al

    . Providing positive primary care experiences for homeless veterans through tailored medical homes: the Veterans Health Administration's Homeless Patient Aligned Care Teams. Med Care 2019;57:270–8.

    OpenUrlCrossRefPubMed
15. 15.↵
    1. Kertesz SG,
    2. deRussy AJ,
    3. Kim YI,
    4. et al

    . Comparison of patient experience between primary care settings tailored for homeless clientele and mainstream care settings. Med Care 2021;59:495–503.

    OpenUrlPubMed
16. 16.↵
    1. Schuttner L,
    2. Guo R,
    3. Wong E,
    4. et al

    . High-risk patient experiences associated with an intensive primary care management program in the Veterans Health Administration. J Ambul Care Manage 2023;46:45–53.

    OpenUrlPubMed
17. 17.↵
    1. Zulman DM,
    2. Chang ET,
    3. Wong A,
    4. et al

    . Effects of intensive primary care on high-need patient experiences: survey findings from a Veterans Affairs randomized quality improvement trial. J Gen Intern Med 2019;34:75–81.

    OpenUrlCrossRef
18. 18.↵
    1. Mautner DB,
    2. Pang H,
    3. Brenner JC,
    4. et al

    . Generating hypotheses about care needs of high utilizers: lessons from patient interviews. Popul Health Manag 2013;16 Suppl 1:S26–33.

    OpenUrl
19. 19.↵
    1. Wong MS,
    2. Luger TM,
    3. Katz ML,
    4. et al

    . Outcomes that matter: high-needs patients' and primary care leaders' perspectives on an intensive primary care pilot. J Gen Intern Med 2021;36:3366–72.

    OpenUrlPubMed
20. 20.↵
    1. Chan B,
    2. Edwards ST,
    3. Devoe M,
    4. et al

    . The SUMMIT ambulatory-ICU primary care model for medically and socially complex patients in an urban federally qualified health center: study design and rationale. Addict Sci Clin Pract 2018;13:27.

    OpenUrlPubMed
21. 21.↵
    1. Kangovi S,
    2. Mitra N,
    3. Grande D,
    4. et al

    . Patient-centered community health worker intervention to improve posthospital outcomes: a randomized clinical trial. JAMA Intern Med 2014;174:535–43.

    OpenUrlPubMed
22. 22.↵
    1. Vartanian K,
    2. Ts Wright B,
    3. Li G,
    4. Holtforf M,
    5. Levinson M

    . The Health Resilience Program: a program assessment. The Center for Outcomes Research & EducationProvidence Health & Services, January 2016 2016. (Available at: https://www.careinnovations.org/wp-content/uploads/CORE-Health-Resilience-Program-Assessment.pdf).
23. 23.↵
    Dedoose Version 8.0.35, web application for managing, analyzing, and presenting qualitative and mixed method research data (2018). Los Angeles, CA: SocioCultural Research Consultants, LLC Available at: www.dedoose.com.
24. 24.↵
    1. Braun V,
    2. Clarke V

    . Reflecting on reflexive thematic analysis. Qualitative research in sport, exercise and health 2019;11:589–97.

    OpenUrlCrossRef
25. 25.↵
    1. Braun V,
    2. Clarke V

    . Using thematic analysis in psychology. Qualitative research in psychology 2006;3:77–101.

    OpenUrlCrossRef
26. 26.↵
    1. Hsieh HF,
    2. Shannon SE

    . Three approaches to qualitative content analysis. Qual Health Res 2005;15:1277–88.

    OpenUrlCrossRefPubMedWeb of Science
27. 27.↵
    1. Gelberg L,
    2. Andersen RM,
    3. Leake BD

    . The behavioral model for vulnerable populations: application to medical care use and outcomes for homeless people. Health Serv Res 2000;34:1273–302. (Available at: http://www.ncbi.nlm.nih.gov/pubmed/10654830).

    OpenUrlPubMedWeb of Science
28. 28.↵
    1. O'Toole TP,
    2. Johnson EE,
    3. Borgia M,
    4. et al

    . Population-tailored care for homeless veterans and acute care use, cost, and satisfaction: a prospective quasi-experimental trial. Prev Chronic Dis 2018;15:E23.

    OpenUrlPubMed
29. 29.↵
    1. Chang ET,
    2. Yoon J,
    3. Esmaeili A

    , PACT Intensive Management (PIM) Demonstration Sites, PIM National Evaluation Center, and PIM Executive Committeeet al. Outcomes of a randomized quality improvement trial for high-risk veterans in year two. Health Serv Res 2021;56 Suppl 1:1045–56. (In eng).

    OpenUrl
30. 30.↵
    1. Berkowitz SA,
    2. Baggett TP,
    3. Edwards ST

    . Addressing health-related social needs: value-based care or values-based care? J Gen Intern Med 2019;34:1916–8.

    OpenUrlPubMed
31. 31.↵
    1. Beach MC,
    2. Inui T

    , Relationship-Centered Care Research N. Relationship-centered care. A constructive reframing. J Gen Intern Med 2006;21 Suppl 1:S3–8.

    OpenUrlPubMed
32. 32.↵
    1. Chan B,
    2. Hulen E,
    3. Edwards S,
    4. Mitchell M,
    5. Nicolaidis C,
    6. Saha S

    . “It's like riding out the chaos”: caring for socially complex patients in an ambulatory intensive care unit (A-ICU). Ann Fam Med 2019;17:495–501.

    OpenUrlAbstract/FREE Full Text
33. 33.↵
    1. Reblin M,
    2. Uchino BN

    . Social and emotional support and its implication for health. Curr Opin Psychiatry 2008;21:201–5.

    OpenUrlCrossRefPubMedWeb of Science
34. 34.↵
    1. Uchino BN,
    2. Cacioppo JT,
    3. Kiecolt-Glaser JK

    . The relationship between social support and physiological processes: a review with emphasis on underlying mechanisms and implications for health. Psychol Bull 1996;119:488–531. (Available at: http://www.ncbi.nlm.nih.gov/pubmed/8668748 http://psycnet.apa.org/journals/bul/119/3/488/).

    OpenUrlCrossRefPubMedWeb of Science
35. 35.↵
    1. Tuepker A,
    2. Newell S,
    3. Nicolaidis C,
    4. et al

    . Veteran patient perspectives and experiences during implementation of a patient-centered medical home model. J Patient Exp 2018;5:107–13.

    OpenUrlPubMed
36. 36.↵
    1. Webster F,
    2. Christian J,
    3. Mansfield E

    , BRIDGES Collaborativeet al. Capturing the experiences of patients across multiple complex interventions: a meta-qualitative approach. BMJ Open 2015;5:e007664.

    OpenUrlAbstract/FREE Full Text
37. 37.↵
    1. Grinberg C,
    2. Hawthorne M,
    3. LaNoue M,
    4. Brenner J,
    5. Mautner D

    . The core of care management: the role of authentic relationships in caring for patients with frequent hospitalizations. Popul Health Manag 2016;19:248–56. (In eng).

    OpenUrlPubMed
38. 38.↵
    1. Scott JG,
    2. Cohen D,
    3. Dicicco-Bloom B,
    4. Miller WL,
    5. Stange KC,
    6. Crabtree BF

    . Understanding healing relationships in primary care. Ann Fam Med 2008;6:315–22.

    OpenUrlAbstract/FREE Full Text
39. 39.↵
    1. Beach MC,
    2. Keruly J,
    3. Moore RD

    . Is the quality of the patient-provider relationship associated with better adherence and health outcomes for patients with HIV? J Gen Intern Med 2006;21:661–5.

    OpenUrlCrossRefPubMedWeb of Science
40. 40.↵
    1. Hulen E,
    2. Laliberte AZ,
    3. Katz ML,
    4. et al

    . Patient selection strategies in an intensive primary care program. Healthc (Amst) 2022;10:100627.

    OpenUrlPubMed