VA health service utilization for homeless and low-income Veterans: a spotlight on the VA Supportive Housing (VASH) program in greater Los Angeles.
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.


OBJECTIVE
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.


METHODS
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.
*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.
Sonya
S
Gabrielian
Anita H
AH
Yuan
Ronald M
RM
Andersen
Lisa V
LV
Rubenstein
Lillian
L
Gelberg
D000368:Aged; D019090:Case Management / Q000458:organization & administration / Q000706:statistics & numerical data; D005260:Female; D015438:Health Behavior; D006296:Health Services / Q000706:statistics & numerical data*; D006703:Ill-Housed Persons / Q000706:statistics & numerical data*; D006801:Humans; D015141:Los Angeles; D008297:Male; D017533:Marital Status; D008605:Mental Health Services / Q000706:statistics & numerical data; D008875:Middle Aged; D011203:Poverty / Q000706:statistics & numerical data*; D011638:Public Housing / Q000706:statistics & numerical data*; D044469:Racial Groups; D014481:United States; D014493:United States Department of Veterans Affairs / Q000458:organization & administration* / Q000706:statistics & numerical data