Interventions for Health: Why and How Health Care Systems Provide Programs to Benefit Unhoused Patients.

Individuals experiencing homelessness have poorer health than housed individuals, while also utilizing more emergency department care and fewer preventive services. Several interventions - including permanent supportive housing, medical respite, and mobile medical clinics - are cost-effective means to improve health outcomes for homeless populations, yet few health systems have invested in such programs. This study aimed to determine the reasons some health systems initiated these interventions, and the early experience of those health systems that did. Quantitative analyses of health systems in 4 states with high levels of homelessness showed that interventions to improve the health of homeless populations were more common in larger hospitals, teaching hospitals, religious hospitals, network-affiliated hospitals, and hospitals in California. Interviews confirmed that health systems typically were moved to implement these interventions by more than 1 factor, including financial goals, mission-driven motives, a desire to improve care quality, and recognition of local need. Interviewees reported collaborations with community service providers, and some reported targeting services to specific subpopulations. Health systems reported success with some initiatives but noted that success was contingent on overcoming barriers including funding, opposition from the local community, challenges building true partnerships with service providers, and the reluctance of some homeless patients to receive services. Health systems may be encouraged by the results reported by early adopters who navigated these obstacles, while policy makers might consider incentivizing health systems to engage in these interventions by providing a dedicated funding stream.

Examining the Relationship Between Perceived Quality of Care and Actual Quality of Care as Measured by 30-Day Readmission Rates.

OBJECTIVE: To test the relationship between patient experience, as measured by the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS), and actual quality of care, as measured by 30-day readmission rates. DATA SOURCES: Both HCAHPS data and outcome data reported to the Centers of Medicare & Medicaid Services (CMS). STUDY DESIGN: This secondary, nationwide (N = 4060), hospital-level study focused only on acute care hospitals. HCAHPS question 22 "Would you recommend this hospital to your friends and family?" was used to determine level of overall satisfaction, and 30-day readmission rates, as reported to the CMS, was used as a proxy for actual quality of care. PRINCIPAL FINDINGS: A statistically significant relationship was found between patient experience and actual quality outcomes. CONCLUSION: The results of this study reinforce the inclusion of patient experience in Medicare's Value Based Purchasing program as a matter of good public policy.