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Health Services Research & Development

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HSR&D In Progress

April 2016

In this Issue: Working to End Homelessness among Veterans
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Early Warning Indicators of Homelessness Risk among Veterans

Ongoing study

Those 'at-risk' of homelessness, especially for the first time, are a major focus of VA's prevention efforts. Early warning indicators to identify these Veterans are currently only inferred from known risk factors for homelessness that can be gleaned from administrative data. However, references to indicators of risk in clinical narratives written by VA providers may precede the formal identification of Veterans as being homeless, potentially representing an untapped resource for early identification. This ongoing study seeks to develop electronic algorithms to identify Veterans who are currently homeless, or those who are at risk of homelessness, and to review the extent to which Veterans are receiving appropriate services.

Investigators examined VA health records from 2002 to 2012 to identify Veterans recently separated from the military, and who were homeless.

Findings

Using VA conventional criteria (i.e., ICD-9-CM code), investigators identified 21,021 homeless Veterans from Operations Enduring Freedom, Iraqi Freedom, and New Dawn (rate 2.5%). Adding allied V60 codes, which also indicate housing instability, increased the number of OEF/OIF/OND Veterans to 31,260 (rate 3.3%). Veterans identified as homeless using conventional or allied codes were similar with regards to utilization of homeless, mental health, and substance abuse services, as well as comorbidities. Investigators also assessed the association between misconduct-related separations and homelessness, and found that Veterans who separated from the military for misconduct were at nearly 7 times likelihood of becoming homeless compared to those with a normal separation.

Impact

Creating an official VA case definition for homelessness, which includes additional ICD-9-CM and other administrative codes for VA homeless services, would allow improved identification of homeless and at-risk Veterans. Further, to prevent homelessness there is a need for identification and provision of case management and rehabilitative services to those with misconduct-related, as well as all non-normal separations at the time of leaving the military.

Principal Investigator: Adi Gundlapalli, MD, PhD, HSR&D's Informatics, Decision-Enhancement and Analytic Sciences Center (IDEAS 2.0), and the VA Salt Lake City Health Care System.

Gundlapalli AV, Fargo J, et al. Military misconduct and homelessness among US Veterans separated from active duty, 2001-2012. JAMA. August 25, 2015;314(8):832-4.

Peterson R, Gundlapalli AV, Metraux S, et al. Identifying homelessness among Veterans using VA administrative data: Opportunities to expand detection criteria. PLoS ONE. July 2015;10(7).

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