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VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles.
Med Care. 2014 May; 52(5):454-61.MC

Abstract

BACKGROUND

The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing.

OBJECTIVES

We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans.

RESEARCH DESIGN

We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status.

RESULTS

HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group.

CONCLUSIONS

Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care.

Authors+Show Affiliations

*Department of Psychiatry †Mental Illness Research, Education & Clinical Center ‡Health Services Research & Development Center of Excellence for the Study of Healthcare Provider Behavior, VA Greater Los Angeles §Department of Psychiatry and Biobehavioral Sciences, UCLA ∥Veterans Emergency Management Evaluation Center ¶School of Public Health, UCLA #Department of Medicine, VA Greater Los Angeles, Los Angeles **RAND Corp., Santa Monica ††Department of Family Medicine, UCLA, Los Angeles, CA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, Non-P.H.S.
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

24714583

Citation

Gabrielian, Sonya, et al. "VA Health Service Utilization for Homeless and Low-income Veterans: a Spotlight On the VA Supportive Housing (VASH) Program in Greater Los Angeles." Medical Care, vol. 52, no. 5, 2014, pp. 454-61.
Gabrielian S, Yuan AH, Andersen RM, et al. VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. Med Care. 2014;52(5):454-61.
Gabrielian, S., Yuan, A. H., Andersen, R. M., Rubenstein, L. V., & Gelberg, L. (2014). VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. Medical Care, 52(5), 454-61. https://doi.org/10.1097/MLR.0000000000000112
Gabrielian S, et al. VA Health Service Utilization for Homeless and Low-income Veterans: a Spotlight On the VA Supportive Housing (VASH) Program in Greater Los Angeles. Med Care. 2014;52(5):454-61. PubMed PMID: 24714583.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles. AU - Gabrielian,Sonya, AU - Yuan,Anita H, AU - Andersen,Ronald M, AU - Rubenstein,Lisa V, AU - Gelberg,Lillian, PY - 2014/4/10/entrez PY - 2014/4/10/pubmed PY - 2014/6/3/medline SP - 454 EP - 61 JF - Medical care JO - Med Care VL - 52 IS - 5 N2 - BACKGROUND: The US Department of Housing and Urban Development (HUD)-VA Supportive Housing (VASH) program-the VA's Housing First effort-is central to efforts to end Veteran homelessness. Yet, little is known about health care utilization patterns associated with achieving HUD-VASH housing. OBJECTIVES: We compare health service utilization at the VA Greater Los Angeles among: (1) formerly homeless Veterans housed through HUD-VASH (HUD-VASH Veterans); (2) currently homeless Veterans; (3) housed, low-income Veterans not in HUD-VASH; and (4) housed, not low-income Veterans. RESEARCH DESIGN: We performed a secondary database analysis of Veterans (n=62,459) who received VA Greater Los Angeles care between October 1, 2010 and September 30, 2011. We described medical/surgical and mental health utilization [inpatient, outpatient, and emergency department (ED)]. We controlled for demographics, need, and primary care use in regression analyses of utilization data by housing and income status. RESULTS: HUD-VASH Veterans had more inpatient, outpatient, and ED use than currently homeless Veterans. Adjusting for demographics and need, HUD-VASH Veterans and the low-income housed Veterans had similar likelihoods of medical/surgical inpatient and outpatient utilization, compared with the housed, not low-income group. Adjusting first for demographics and need (model 1), then also for primary care use (model 2), HUD-VASH Veterans had the greatest decrease in incident rates of specialty medical/surgical, mental health, and ED care from models 1 to 2, becoming similar to the currently homeless, compared with the housed, not low-income group. CONCLUSIONS: Our findings suggest that currently homeless Veterans underuse health care relative to housed Veterans. HUD-VASH may address this disparity by providing housing and linkages to primary care. SN - 1537-1948 UR - https://www.unboundmedicine.com/medline/citation/24714583/VA_health_service_utilization_for_homeless_and_low_income_Veterans:_a_spotlight_on_the_VA_Supportive_Housing__VASH__program_in_greater_Los_Angeles_ L2 - https://doi.org/10.1097/MLR.0000000000000112 DB - PRIME DP - Unbound Medicine ER -