Developing an operational definition of housing instability and homelessness in Veterans Health Administration’s medical records

Abstract

The main objective of this study was to examine how homelessness and housing instability is captured across data sources in the Veterans Health Administration (VHA). Data from 2021 were extracted from three data repositories, including the Corporate Data Warehouse (CDW), the Homeless Operations Management System (HOMES), and the Homeless Management Information System (HMIS). Using these three data sources, we identified the number of homeless and unstably housed veterans across a variety of indicators. The results showed that the use of diagnostic codes and clinic stop codes identified a large number of homeless and unstably housed veterans, but the use of HOMES and HMIS data identified additional homeless and unstably housed veterans to provide a complete count. A total of 290,431 unique veterans were identified as experiencing homelessness or housing instability in 2021 and there was regional variability in how homelessness and housing stability were captured across data sources, supporting the need for more uniform ways to operationalize these conditions. Together, these findings highlight the and encourage use of all available indicators and data sources to identify homelessness and housing instability in VHA. These methodologies applied to the largest healthcare system in the U.S. demonstrate their utility and possibilities for other healthcare systems. Transparent practices about data sources and indicators used to capture homelessness and housing instability should be shared to increase uniform use.

Epidemiology and Psychiatric Correlates of Cancer among Homeless and Unstably Housed Veterans in the VA Health Care System

“…We selected these years of data because they were the most recent for which the total number of cancer cases was comparable to those provided in a previous article using 2007 and 2010 VACCR data (14). Per standard practice (16), we identified as HUH any veteran who had an ICD-10 code Z59.0, participated in any VA homeless program, or screened positive for homelessness or risk of homelessness on the VA homeless risk screening clinical reminder. Veterans who screened negative for both homelessness and risk of homelessness were presumed to be SH.…”

How often does homelessness precede criminal arrest in veterans? Results from the U.S. survey of prison inmates.

“…Based on implications for clinical assessment and prevention, the findings from the present study provide specific policy guidance to federal programs serving veterans experiencing homelessness. The Department of Veterans Affairs oversees numerous programs to help veterans experiencing homelessness, and the VA articulates an operational definition of homelessness based on a combination of diagnostic codes, a positive screen of homelessness, and/or records of homeless program use (Tsai et al, 2022). The Department of Housing and Urban Development also provides housing services to veterans and nonveterans.…”

Housing Status, Cancer Care, and Associated Outcomes Among US Veterans

“…We classified veterans as experiencing homelessness if they had any indicators of homelessness in outpatient visits, clinic reminders, diagnosis codes, or the Homeless Operations Management Evaluation System (eAppendix in Supplement 1) in the 12 months preceding diagnosis with no subsequent evidence of stable housing (before diagnosis). Use of these multiple sources has been shown to identify more veterans experiencing homelessness than relying on any one indicator; as such, it is considered best practice to use all of the indicators to fully capture homelessness . After diagnosis, we characterized patients as persistently experiencing homelessness if they had no evidence of stable housing in the 12 months after diagnosis.…”

“…1,2 Currently, approximately 50% of single adults experiencing homelessness are aged older than 50 years, the age at which the incidence of cancer increases and many adults are recommended to undergo cancer screening. [3][4][5] Evaluation System 15,16 (eAppendix in Supplement 1) in the 12 months preceding diagnosis with no subsequent evidence of stable housing (before diagnosis). Use of these multiple sources has been shown to identify more veterans experiencing homelessness than relying on any one indicator; as such, it is considered best practice to use all of the indicators to fully capture homelessness.…”

“…Use of these multiple sources has been shown to identify more veterans experiencing homelessness than relying on any one indicator; as such, it is considered best practice to use all of the indicators to fully capture homelessness. 16 After diagnosis, we characterized patients as persistently experiencing homelessness if they had no evidence of stable housing in the 12 months after diagnosis. We characterized patients experiencing homelessness as having gained housing if they subsequently had evidence of stable housing in the 12 months after diagnosis.…”