Storylines of family medicine IX: people and places-diverse populations and locations of care.

is a 12-part series of thematically linked mini-essays with accompanying illustrations that explore the many dimensions of family medicine as interpreted by individual family physicians and medical educators in the USA and elsewhere around the world. In 'IX: people and places-diverse populations and locations of care', authors address the following themes: 'LGBTQIA+health in family medicine', 'A family medicine approach to substance use disorders', 'Shameless medicine for people experiencing homelessness', '''Difficult" encounters-finding the person behind the patient', 'Attending to patients with medically unexplained symptoms', 'Making house calls and home visits', 'Family physicians in the procedure room', 'Robust rural family medicine' and 'Full-spectrum family medicine'. May readers appreciate the breadth of family medicine in these essays.

Determinants of High Psychiatric Utilization at a Large Urban Safety-Net Hospital.

Research indicates that high utilizers of the health care system are more likely to have mental illness, to be from socially disadvantaged groups, and to have limited access to community-based services. In this retrospective study, three definitions of high utilization were examined: (1) across time: non-high utilization versus high-utilization, (2) single year versus multi-year, and (3) year-to-year. Univariate logistic regression models were fit to a set of 20 theory-selected predictors of high utilization.

Values-Based Interventions in Patient Engagement for Those with Complex Needs.

The objective was to evaluate a novel intervention that integrates a psychological, values-based approach with coordinated care management. This paper describes an integrated comprehensive health record system to enhance engagement with a subset of those with complex needs; those who are high-needs, high-cost (HNHC). Patients are selected after conducting data analysis on the most costly and complex patients of a payer system that works with HNHC patients.

Shaping the Jail Inreach Project: program evaluation as a quality improvement measure to inform programmatic decision making and improve outcomes.

The Jail Inreach Project was initiated in 2007 as a pilot program by Healthcare for the Homeless-Houston, an FQHC serving homeless individuals in Harris County, Texas, as a collaborative effort with the Harris County Sheriff's Office and the Mental Health Mental Retardation Authority of Harris County. It addresses the disproportionate number of homeless individuals with behavioral health diagnoses cycling through the Harris County Jail without provisions for continuity of care. Throughout the years, several evaluations have been conducted to inform programmatic planning and assess the success of the program on affecting patterns of recidivism of mentally ill homeless clients being served.

Prevalence of bipolar disorder and schizophrenia in Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic patients: implications for student-managed clinics for underserved populations.

Purpose: Psychiatric conditions require aggressive management that is challenging to provide in free clinics. The purpose of this study was to determine the prevalence of certain mental illnesses and comorbid conditions among the patients of a student-managed free clinic for the homeless.

Method: The authors conducted a retrospective analysis of the records of patients who visited the student-run Houston Outreach Medicine, Education, and Social Services (HOMES) Clinic from May 2007 through May 2008.

Comparing homeless and domiciled patients' utilization of the Harris County, Texas public hospital system.

Homeless individuals have mortality rates three to six times higher than their housed counterparts and have elevated rates of mental illness, substance abuse, and co-morbidities that increase their need for health services. Data on the utilization of Harris County, Texas' public hospital system by 331 homeless individuals and a random sample of 17,824 domiciled patients were obtained from June 2008 to July 2009. Homeless individuals had increased readmission rates, especially within 30 days of discharge, resulting in significantly higher total annual length of stay.

The Jail Inreach Project: linking homeless inmates who have mental illness with community health services.

The Jail Inreach Project is a health care-based intensive case management "inreach" program that engages incarcerated persons from the homeless population who have behavioral health disorders (mental illness, substance use disorder, or both) in establishing a plan for specific postrelease services. The Jail Inreach Project aims to provide continuity of care and integrate this highly marginalized subpopulation of homeless persons into primary and behavioral health care systems by establishing patient-centered health homes. The use of integrated primary and behavioral health models in conjunction with provisions for immediate access to and continuity of care upon release is emerging as a best practice in combating the rapid cycling of this vulnerable population between streets and shelters, emergency centers, and the county jail.

Delivering health care on the streets: challenges and opportunities for quality management.

Street Medicine focuses on the health needs of unsheltered homeless through mobile teams that provide care in the locations where individuals are found. Innovative strategies are needed to manage the quality of care provided within the atypical clinical settings encountered. In our study, contextual elements and practices for managing quality of care were explored through qualitative analysis of program components presented at the 2007 and 2008 International Street Medicine Symposia.

Taking it to the streets: recording medical outreach data on personal digital assistants.

Carrying hundreds of patient files in a suitcase makes medical street outreach to the homeless clumsy and difficult. Healthcare for the Homeless--Houston (HHH) began a case study under the assumption that tracking patient information with a personal digital assistant (PDA) would greatly simplify the process. Equipping clinicians with custom-designed software loaded onto Palm V Handheld Computers (palmOne, Inc, Milpitas, CA), Healthcare for the Homeless--Houston assessed how this type of technology augmented medical care during street outreach to the homeless in a major metropolitan area.

Design and validation of the Health Professionals' Attitudes Toward the Homeless Inventory (HPATHI).

Background: Recent literature has called for humanistic care of patients and for medical schools to begin incorporating humanism into medical education. To assess the attitudes of health-care professionals toward homeless patients and to demonstrate how those attitudes might impact optimal care, we developed and validated a new survey instrument, the Health Professional Attitudes Toward the Homeless Inventory (HPATHI). An instrument that measures providers' attitudes toward the homeless could offer meaningful information for the design and implementation of educational activities that foster more compassionate homeless health care.

Involving homeless persons in the leadership of a health care organization.

Consumer advisory boards (CABs) are a way of involving patients in their health care. To engage the homeless in the administration of a health care organization for the homeless, a service agency formed such a board comprising homeless and formerly homeless individuals. The purpose was to integrate experiences of homelessness into programmatic design and research efforts of the organization, and to promote participatory research among the homeless.

A multidisciplinary, learner-centered, student-run clinic for the homeless.

Background And Objectives: Houston Outreach Medicine Education and Social Services teaches students, in multidisciplinary teams, using the learner-centered model, to provide primary health care to the homeless.

Description: The founding and operational aspects of this educational intervention are presented.

Evaluation: Student response to this service-learning program is assessed in terms of educational value using a survey and an analysis of student reflections.