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Aligning Resources to Care for Homeless Veterans (ARCH)

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ClinicalTrials.gov Identifier: NCT01550757
Recruitment Status : Completed
First Posted : March 12, 2012
Results First Posted : October 11, 2017
Last Update Posted : October 11, 2017
Sponsor:
Information provided by (Responsible Party):
VA Office of Research and Development

Brief Summary:
"Aligning Resources to Care for Homeless Veterans" (ARCH) will study ways to best organize and deliver primary care for homeless Veterans. The investigators will assess 4 different adaptations of the PACT primary care model in a mixed methods study that includes multi-center, randomized-controlled trials of embedded peer-mentoring within different iterations of the PACT model, focus groups of study participants assessing satisfaction, treatment engagement and self-efficacy within the different care models and a cost-utility analysis to determine the most cost-efficient approach to organizing care for this population. Findings from this study will help determine optimal care approaches for reducing emergency department visits and acute hospitalizations, increasing patient satisfaction, and improving chronic disease management. Findings from this study will also substantively add to our understanding of health seeking behavior and the care of vulnerable/high-risk Veteran populations as well as clinical systems design. This project reflects a true "field-based study" to identify optimal and feasible approaches to patient care within our current VHA system. Finally, it will help inform pressing policy issues relevant to two identified T-21 priority areas: Ending Veteran Homelessness in 5 Years and Transforming to a Patient Centered Primary Care model.

Condition or disease Intervention/treatment Phase
Homeless Persons Primary Health Care Behavioral: Embedded Peer Mentor Not Applicable

  Show Detailed Description

Study Type : Interventional  (Clinical Trial)
Actual Enrollment : 382 participants
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: Single (Care Provider)
Primary Purpose: Health Services Research
Official Title: Aligning Resources to Care for Homeless Veterans (ARCH)
Study Start Date : March 2012
Actual Primary Completion Date : September 2014
Actual Study Completion Date : September 2016

Arm Intervention/treatment
No Intervention: Arm 1
Normal PACT Clinical Care
Experimental: Arm 2
Normal PACT Clinical Care + Embedded Peer Mentor
Behavioral: Embedded Peer Mentor
This intervention/condition consists of a formerly homeless individual embedded in the PACT or H-PACT clinic team. This person is responsible for community-based follow-up for homeless patients randomly assigned to him or her. In addition to structured, scheduled meetings with assigned study subjects, the peer mentor will also participate in PACT/H-PACT team meetings and serve as a liaison between the study subject and his or her primary care team. Peer mentors will be hired as VA term employees in Research.
No Intervention: Arm 3
Normal Homeless Oriented PACT Clinical Care
Experimental: Arm 4
Normal Homeless Oriented PACT Clinical Care + Embedded Peer Mentor
Behavioral: Embedded Peer Mentor
This intervention/condition consists of a formerly homeless individual embedded in the PACT or H-PACT clinic team. This person is responsible for community-based follow-up for homeless patients randomly assigned to him or her. In addition to structured, scheduled meetings with assigned study subjects, the peer mentor will also participate in PACT/H-PACT team meetings and serve as a liaison between the study subject and his or her primary care team. Peer mentors will be hired as VA term employees in Research.



Primary Outcome Measures :
  1. A Primary Outcome for This Study is the Number of Non-acute Emergency Department Visits. [ Time Frame: Two years. ]
    A primary outcome for this study is non-acute emergency department visits.



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Ages Eligible for Study:   18 Years to 80 Years   (Adult, Senior)
Sexes Eligible for Study:   All
Accepts Healthy Volunteers:   Yes
Criteria

Inclusion Criteria:

  • The study population will be homeless Veterans enrolled in primary care (including both new and established patients who are homeless at the time of enrollment).
  • Currently homeless to include: unsheltered; staying in an emergency shelter; in transitional/Grant and Per Diem housing; or doubled-up with a family member or friend and not paying rent.

Exclusion Criteria:

  • Currently enrolled in Mental Health Intensive Case Management (MHICM) or other VA-based case/care managed program;
  • Stated plans to leave the area within 6 months of enrollment;
  • Unable or unwilling to provide informed consent;
  • Pregnant women will because excluded because we do not wish to detract from the amount of specialty care and services they receive and need.

Information from the National Library of Medicine

To learn more about this study, you or your doctor may contact the study research staff using the contact information provided by the sponsor.

Please refer to this study by its ClinicalTrials.gov identifier (NCT number): NCT01550757


Locations
United States, California
San Francisco VA Medical Center, San Francisco, CA
San Francisco, California, United States, 94121
United States, Rhode Island
Providence VA Medical Center, Providence, RI
Providence, Rhode Island, United States, 02908
Sponsors and Collaborators
VA Office of Research and Development
Investigators
Principal Investigator: Thomas P O'Toole, MD Providence VA Medical Center, Providence, RI