Priorities in the primary care of persons experiencing homelessness: convergence and divergence in the views of patients and provider/experts

Figures & data

Table 1 Primary care quality constructs derived from two IoM reports and their ordinal ranking among patients and provider/experts in homeless health carea

IoM construct	Statements ranked in card sort exercise: “Primary care should …”	Homeless patients	Provider/experts in homeless care
Accessibility	Be easy to get	1	1
Evidence-based decision making	Be based on the best medical knowledge	2	2
Cooperation	Mean all of those who take care of a patient to work as a team and talk to each other	3	4 (tied with source of control)
Coordination	Make sure a patient can get all the services they need even if it is from more than one person	4 (tied with shared knowledge)	6
Shared knowledge and the free flow of information	Make it easy for patients to get information about their care	4 (tied with coordination)	14
Accountability for addressing majority of health needs	Meet most of a patient’s health needs, most of the time	6	3
Sustained partnership	Mean the provider and the patient work together over a long period of time	7	12
Continuous (not just visit-based) healing relationships	Be available any time or any place patients need it	8	10
Anticipation of needs	Plan for a patient’s future needs, instead of waiting for persons to say they have a need	9	7
Patient as a source of control	Give patients control in their health care	10	4 (tied with cooperation)
Safety as a system priority	Keep in mind safety	11	11
Transparency	Allow patients to know how well their primary care providers do their jobs	12	15
Choices in primary care should be based on a patient’s values	Be based on your values	13	8
Decrease in waste, optimize value	Not waste money or time	14	16
Context of community and family	Keep in mind the people who are in a patient’s life or not in a patient’s life	15	13
Context of community and family	Keep in mind where a person lives	16	9

Notes:

a The ordinal ranking shown in this table (from 1 to 16) was obtained as follows. We computed the mean value (ie, its position within the deck of 16 cards provided) for each construct, separately for patients and providers. These mean values were then ordered from lowest (most important) to highest (least important) to illustrate their relative importance to patients and to providers.

Abbreviation: IoM, Institute of Medicine.

Figure 1 Frequency of rankings among patients and provider/experts for selected primary care quality constructs.

Notes: Frequency of rankings (range 1= most important; 16= least important) assigned to four selected primary-care-related constructs in a card sort exercise undertaken by 26 homeless patients and ten provider/experts with professional focus on homeless health care. Two constructs at left (accessibility and evidence-based decision making) obtained high prioritization from both providers and patients. Two shown at right (patient as source of control; shared knowledge and the free flow of information) diverged, although overlap was seen. The circle size reflects the number of persons who endorsed the construct for the rank shown.