Suchergebnisse

We examined the use of health and behavioral health services for two groups of homeless veterans (N = 1,302) in the New York City area who were enrolled in the U.S. Department of Veterans Affairs (VA) healthcare system—veterans who use VA homeless programs, and veterans who use mainstream homeless programs only. Using administrative records from the VA and the New York City Department of Homeless Services, we compared the characteristics of users of VA and mainstream homeless programs and examined between‐group differences in VA inpatient and outpatient services use and within‐group changes in services use prior and subsequent to onset of homelessness. Roughly 41 percent of veterans only used mainstream homeless services. There were no significant differences between users of VA and mainstream homeless services in terms of gender, age, ethnicity, and level of VA eligibility. Veterans who used only mainstream homeless assistance services were less likely to be engaged with—and made less intensive use of—VA health and behavioral health inpatient and outpatient services than those who used VA homeless services. Efforts should be made to identify and engage veterans who, while enrolled in VA healthcare, may go unidentified as homeless by the VA.

Objectives. We determined whether a report of adverse childhood experiences predicts adult outcomes related to homelessness, mental health, and physical health and whether participation in active military service influences the relationship between childhood and adult adversity.

Effectiveness of screening for homelessness in a large healthcare system was evaluated in terms of successfully referring and connecting patients with appropriate prevention or intervention services. Screening and healthcare services data from nearly 6 million U.S. military veterans were analyzed. Veterans either screened positive for current or risk of housing instability, or negative for both. Current living situation was used to validate results of screening. Administrative evidence for homelessness-related services was significantly higher among positive-screen veterans who accepted a referral for services compared to those who declined. Screening for current or risk of homelessness led to earlier identification, which led to earlier and more extensive service engagement.

OBJECTIVE: To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a VA homelessness program on these outcomes. DATA SOURCES/STUDY SETTING: Combined Department of Veterans Affairs (VA) administrative and Medicare claims data. STUDY DESIGN: Observational study using longitudinal data from Veterans engaged with the VA system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006–2010 were matched on period of military service to Veterans with no evidence of homelessness. PRINCIPAL FINDINGS: Experience of homelessness was associated with 1.37 (95 percent CI = 1.34–1.40) and 0.16 (95 percent CI = 0.14–0.17) more outpatient encounters per quarter in VA and non‐VA settings, respectively, and 1.31 (95 percent CI = 1.30–1.32) and 0.49 (95 percent CI = 0.48–0.49) more inpatient days per quarter in VA and non‐VA hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65 years of age, those enrolled in a VA homelessness program had 94.4 percent (95 percent CI = 90.7 percent–98.1 percent) more VA outpatient visits but 5.5 percent (95 percent CI = 3.0 percent–7.9 percent) fewer Medicare outpatient visits. CONCLUSIONS: Homelessness was associated with an increase in VA and Medicare utilization and cost. A VA homelessness program decreased use of Medicare outpatient services.

BACKGROUND: Health care systems struggle to identify risk factors for suicide. Adverse social determinants of health (SDH) are strong predictors of suicide risk, but most electronic health records (EHR) do not include SDH data. OBJECTIVE: To determine the prevalence of SDH documentation in the EHR and how SDH are associated with suicide ideation and attempt. DESIGN: This cross-sectional analysis included EHR data spanning October 1, 2015–September 30, 2016, from the Veterans Integrated Service Network Region 4. PARTICIPANTS: The study included all patients with at least one inpatient or outpatient visit (n = 293,872). MAIN MEASUREMENTS: Adverse SDH, operationalized using Veterans Health Administration (VHA) coding for services and International Statistical Classification of Diseases and Related Health Problems (ICD)-10 codes, encompassed seven types (violence, housing instability, financial/employment problems, legal problems, familial/social problems, lack of access to care/transportation, and nonspecific psychosocial needs). We defined suicide morbidity by ICD-10 codes and data from the VHA's Suicide Prevention Applications Network. Logistic regression assessed associations of SDH with suicide morbidity, adjusting for socio-demographics and mental health diagnoses (e.g., major depression). Statistical significance was assessed with p < .01. KEY RESULTS: Overall, 16.4% of patients had at least one adverse SDH indicator. Adverse SDH exhibited dose-response-like associations with suicidal ideation and suicide attempt: each additional adverse SDH increased odds of suicidal ideation by 67% (AOR = 1.67, 99%CI = 1.60–1.75; p < .01) and suicide attempt by 49% (AOR = 1.49, 99%CI = 1.33–1.68; p < .01). Independently, each adverse SDH had strong effect sizes, ranging from 1.86 (99%CI = 1.58–2.19; p < .01) for legal issues to 3.10 (99%CI = 2.74–3.50; p < .01) for non-specific psychosocial needs in models assessing suicidal ideation and from 1.58 (99%CI = 1.10–2.27; p < .01) for employment/financial ...

Purpose
Several risk factors have been identified in ongoing efforts by the US Department of Veterans Affairs (VA) to mitigate high rates of homelessness among veterans. To date, no studies have examined the relationship of rurality and distance to nearest VA facility to risk of homelessness. Due to challenges in accessing available services, the hypothesis was that rural-residing veterans are at greater risk for homelessness. The paper aims to discuss these issues.


Design/methodology/approach
The cohort consisted of veterans who had separated from the military between 2001 and 2011. The authors used a forwarding address provided by the service member at the time of separation from the military to determine rurality of residence and distance to care. The authors examined differences in the rate of homelessness within a year of a veteran's first encounter with the VA following last military separation based on rurality and distance to the nearest VA facility using multivariable log-binomial regressions.


Findings
In the cohort of 708,318 veterans, 84.3 percent were determined to have a forwarding address in urban areas, 60.4 and 88.7 percent lived within 40 miles of the nearest VA medical center (VAMC), respectively. Veterans living in a rural area (RR=0.763; 95 percent CI=0.718-0.810) and those living between 20 and 40 miles (RR=0.893; 95 percent CI=0.846-0.943) and 40+ miles away from the nearest VAMC (RR=0.928; 95 percent CI=0.879-0.979) were at a lower risk for homelessness.


Originality/value
The unique data set allowed the authors to explore the relationship between geography and homelessness. These results are important to VA and national policy makers in understanding the risk factors for homelessness among veterans and planning interventions.