262112 Understanding disparities in use of VA services among homeless and other impoverished Veterans

Wednesday, October 31, 2012

Anita Yuan, PhD, MPH , Health Services Research and Development Center, West Los Angeles VA Healthcare Center, Los Angeles, CA
Sonya Gabrielian, MD, MPH , MIRECC, West Los Angeles VA, Los Angeles, CA
Ronald M. Andersen, PhD , Department of Health Services, UCLA School of Public Health, Los Angeles, CA
James McGuire, PhD, LCSW , Incarcerated Veterans Programs, West Los Angeles VA, Los Angeles, CA
John Nakashima, PhD, MSW , Community Care, West Los Angeles VA, Los Angeles, CA
Mingming Wang, MPH , Health Services Research and Development Center, West Los Angeles VA, North Hills, CA
Lisa Rubenstein, MD, MSPH , Center for the Study of Healthcare Provider Behavior, Veterans Health Administration, North Hills, CA
Lillian Gelberg, MD, MSPH , Family Medicine, University of California, Los Angeles, Los Angeles, CA

Homeless persons have high rates of medical and psychiatric illness and unmet healthcare needs. Veterans Administration (VA) studies show that homeless Veterans have worse access to care than their housed peers, with fewer ambulatory visits and lower rates of preventive care.

The VA Greater Los Angeles Healthcare System (VAGLAHS) serves the largest number of homeless Veterans of any VA system in the nation and offers a host of clinical and housing services. At present, the Department of Housing and Urban Development/VA Supported Housing (HUD-VASH) program, a case management initiative for chronically homeless Veterans who are eligible for Section 8 housing, is hailed the most responsive program for this vulnerable population.


Using data from The Veterans Health Information Systems and Technology Architecture (VISTA), we examine VA service utilization for Veterans in the Greater Los Angeles (GLA) catchment area. VISTA contains data on demographics; medical and psychiatric diagnoses; and utilization of medical, mental health, substance abuse, and social services. Data are analyzed for the following subgroups: homeless Veterans in HUD-VASH, other homeless Veterans, low-income Veterans who are not homeless, and other Veterans.


We compare subgroups on: (1) receipt of preventive services, (2) receipt of Emergency Room and inpatient services, including preventable hospitalizations, and (3) receipt of primary care and other ambulatory care. Our findings will inform healthcare organizations, administrators, clinicians and researchers of disparities in utilization of VA medical care for homeless Veterans.

Learning Areas:
Program planning
Systems thinking models (conceptual and theoretical models), applications related to public health

Learning Objectives:
Discuss how homelessness and housing status affects healthcare utilization in the VA. Describe patterns of VA service utilization for Veterans by homelessness status. Discuss implications of VA service utilization for design of healthcare services for homeless Veterans.

Keywords: Homelessness, Needs Assessment

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a sociologist and health services research fellow focused on improving systems of care for homeless Veterans and increasing access to primary care services for this vulnerable population.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.