Implementation of mobile medical units for Veterans experiencing homelessness: A mixed-methods study

Abstract: Mobile medical units (MMUs) provide health care services in the community to reach populations with geographic, financial, and other barriers to care. The US Department of Veterans Affairs (VA) Homeless Patient Aligned Care Team (HPACT) program deployed MMUs to 25 sites in fiscal year 2024 to increase access for veterans experiencing homelessness. We examined early implementation of MMUs in HPACT sites by describing implementation and operational issues, services provided, and characteristics of veterans who used MMUs. To examine the implementation of MMUs on veterans experiencing homelessness, we conducted a mixed-methods study using an online survey and health care administrative data. Measures included MMU implementation time, staffing type, services, safety measures, maintenance costs, and characteristics of veterans using and not using MMUs. We examined differences between veterans who used MMUs and those who did not. Seventeen of 25 sites responded to the survey; MMU implementation occurred during a mean of 147 hours in 5 months. Most sites (15 of 17) visited housing sites and homeless shelters in community- and VA-supported programs to provide health screenings, education, and medication administration and prescribing. Operating costs varied widely for vehicle maintenance and gas and medical and telehealth equipment. Veterans who used MMUs (vs did not use MMUs) had more medical comorbidities (Elixhauser score of 3.4 vs 2.8), were more likely to have substance use disorder (49.9% vs 39.1%), and had higher baseline levels of health care use, especially emergency department visits (0.4 vs 0.3 visits per quarter). Evidence on the effects of MMUs on patient engagement with primary and mental health care and acute care use is needed to inform decisions to implement MMUs.

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