{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,14]],"date-time":"2026-07-14T20:14:39Z","timestamp":1784060079030,"version":"3.55.0"},"reference-count":48,"publisher":"Wiley","issue":"1","license":[{"start":{"date-parts":[[2018,9,21]],"date-time":"2018-09-21T00:00:00Z","timestamp":1537488000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100000738","name":"U.S. Department of Veterans Affairs","doi-asserted-by":"publisher","award":["IIR 13\u2010334"],"award-info":[{"award-number":["IIR 13\u2010334"]}],"id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Health Services Research"],"published-print":{"date-parts":[[2019,2]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To develop and test predictive models of housing instability and homelessness based on responses to a brief screening instrument administered throughout the Veterans Health Administration (<jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content>).<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources\/Study Setting<\/jats:title><jats:p>Electronic medical record data from 5.8 million Veterans who responded to the <jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content>'s Homelessness Screening Clinical Reminder (<jats:styled-content style=\"fixed-case\">HSCR<\/jats:styled-content>) between October 2012 and September 2015.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>We randomly selected 80% of Veterans in our sample to develop predictive models. We evaluated the performance of both logistic regression and random forests\u2014a machine learning algorithm\u2014using the remaining 20% of cases.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Collection\/Extraction Methods<\/jats:title><jats:p>Data were extracted from two sources: <jats:styled-content style=\"fixed-case\">VHA<\/jats:styled-content>'s Corporate Data Warehouse and National Homeless Registry.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Performance for all models was acceptable or better. Random forests models were more sensitive in predicting housing instability and homelessness than logistic regression, but less specific in predicting housing instability. Rates of positive screens for both outcomes were highest among Veterans in the top strata of model\u2010predicted risk.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Predictive models based on medical record data can identify Veterans likely to report housing instability and homelessness, making the <jats:styled-content style=\"fixed-case\">HSCR<\/jats:styled-content> screening process more efficient and informing new engagement strategies. Our findings have implications for similar instruments in other health care systems.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13050","type":"journal-article","created":{"date-parts":[[2018,9,22]],"date-time":"2018-09-22T02:23:24Z","timestamp":1537583004000},"page":"75-85","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":29,"title":["Predictive modeling of housing instability and homelessness in the Veterans Health Administration"],"prefix":"10.1111","volume":"54","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4824-0284","authenticated-orcid":false,"given":"Thomas","family":"Byrne","sequence":"first","affiliation":[{"name":"U.S. Department of Veterans Affairs National Center on Homelessness among Veterans  Philadelphia Pennsylvania"},{"name":"U.S. Department of Veterans Affairs Center for Healthcare Organization and Implementation Research  Bedford Massachusetts"},{"name":"School of Social Work Boston University  Boston Massachusetts"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Elizabeth","family":"Montgomery","sequence":"additional","affiliation":[{"name":"U.S. Department of Veterans Affairs National Center on Homelessness among Veterans  Philadelphia Pennsylvania"},{"name":"Birmingham VA Medical Center  Birmingham Alabama"},{"name":"School of Public Health University of Alabama at Birmingham  Birmingham Alabama"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamison D.","family":"Fargo","sequence":"additional","affiliation":[{"name":"Salt Lake City VA Medical Center  Salt Lake City Utah"},{"name":"Department of Psychology Utah State University  Logan Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,21]]},"reference":[{"issue":"2","key":"e_1_2_6_2_1","first-page":"229","article-title":"Homelessness and health","volume":"164","author":"Hwang S","year":"2001","journal-title":"Can Med Assoc J"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2013.1604"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318206c50d"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.9778\/cmajo.20170018"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199806113382406"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1146\/annurev.publhealth.25.101802.123036"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2014-2888"},{"key":"e_1_2_6_9_1","unstructured":"MahadevanR HoustonR.Supporting Social Service Delivery through Medicaid Accountable Care Organizations: Early State Efforts.https:\/\/www.chcs.org\/media\/Supporting-Social-Service-Delivery-Final_0212151.pdf. 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