• Audrey L Jones, Karen Chu, Danielle E Rose, Lillian Gelberg, Stefan G Kertesz, Adam J Gordon, Kenneth B Wells, and Lucinda Leung.
• Informatics, Decision-Enhancement and Analytic Sciences (IDEAS) Center and Vulnerable Veteran Innovative Patient-Aligned Care Team (VIP) Initiative, VA Salt Lake City Health Care System, Salt Lake City, UT, 84148, USA. Audrey.Jones3@va.gov.
• J Gen Intern Med. 2023 Aug 1; 38 (11): 243624442436-2444.

BackgroundPersons who experience homelessness (PEH) have high rates of depression and incur challenges accessing high-quality health care. Some Veterans Affairs (VA) facilities offer homeless-tailored primary care clinics, although such tailoring is not required, within or outside VA. Whether services tailoring enhances care for depression is unstudied.ObjectiveTo determine whether PEH in homeless-tailored primary care settings receive higher quality of depression care, compared to PEH in usual VA primary care.DesignRetrospective cohort study of depression treatment among a regional cohort of VA primary care patients (2016-2019).ParticipantsPEH diagnosed or treated for a depressive disorder.Main MeasuresThe quality measures were timely follow-up care (3 + completed visits with a primary care or mental health specialist provider, or 3 + psychotherapy sessions) within 84 days of a positive PHQ-2 screen result, timely follow-up care within 180 days, and minimally appropriate treatment (4 + mental health visits, 3 + psychotherapy visits, 60 + days antidepressant) within 365 days. We applied multivariable mixed-effect logistic regressions to model differences in care quality for PEH in homeless-tailored versus usual primary care settings.Key ResultsThirteen percent of PEH with depressive disorders received homeless-tailored primary care (n = 374), compared to usual VA primary care (n = 2469). Tailored clinics served more PEH who were Black, who were non-married, and who had low income, serious mental illness, and substance use disorders. Among all PEH, 48% received timely follow-up care within 84 days of depression screening, 67% within 180 days, and 83% received minimally appropriate treatment. Quality metric attainment was higher for PEH in homeless-tailored clinics, compared to PEH in usual VA primary care: follow-up within 84 days (63% versus 46%; adjusted odds ratio [AOR] = 1.61, p = .001), follow-up within 180 days (78% versus 66%; AOR = 1.51, p = .003), and minimally appropriate treatment (89% versus 82%; AOR = 1.58, p = .004).ConclusionsHomeless-tailored primary care approaches may improve depression care for PEH.© 2023. This is a U.S. Government work and not under copyright protection in the US; foreign copyright protection may apply.

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