*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.
Med Care. 2014 May;52(5):454-61. doi: 10.1097/MLR.0000000000000112.
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.
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.
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.
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.
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.
美国住房和城市发展部（HUD）-VA 支持性住房（VASH）计划——VA 的住房优先计划——是解决退伍军人无家可归问题的核心。然而，对于实现 HUD-VASH 住房相关的医疗保健利用模式，人们知之甚少。
我们比较了在加利福尼亚州洛杉矶 VA 大地区内，通过以下几种方式获得住房的退伍军人的医疗服务利用情况：（1）通过 HUD-VASH 安置的无家可归退伍军人（HUD-VASH 退伍军人）；（2）目前无家可归的退伍军人；（3）有住房的、收入不低的非 HUD-VASH 退伍军人；（4）有住房的、收入不低的退伍军人。
我们对 2010 年 10 月 1 日至 2011 年 9 月 30 日期间在加利福尼亚州洛杉矶 VA 接受治疗的退伍军人（n=62459）进行了二次数据库分析。我们描述了医疗/外科和心理健康利用情况[住院、门诊和急诊部（ED）]。我们在按住房和收入状况对利用数据进行回归分析时，控制了人口统计学因素、需求和初级保健利用情况。
与目前无家可归的退伍军人相比，HUD-VASH 退伍军人的住院、门诊和 ED 利用次数更多。在调整人口统计学因素和需求后，与有住房、收入不低的退伍军人相比，HUD-VASH 退伍军人和有住房、收入低的退伍军人接受医疗/外科住院和门诊治疗的可能性相似。在首先调整人口统计学因素和需求（模型 1），然后还调整初级保健利用情况（模型 2）后，与有住房、收入不低的退伍军人相比，HUD-VASH 退伍军人的特殊医疗/外科、心理健康和 ED 护理的发病率从模型 1 到模型 2 呈最大下降趋势，与目前无家可归的退伍军人相似。
我们的研究结果表明，与有住房的退伍军人相比，目前无家可归的退伍军人对医疗保健的利用不足。HUD-VASH 通过提供住房和与初级保健的联系，可能会解决这一差距。
