{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,15]],"date-time":"2026-07-15T17:28:15Z","timestamp":1784136495938,"version":"3.55.0"},"reference-count":39,"publisher":"Wiley","issue":"S3","license":[{"start":{"date-parts":[[2018,9,23]],"date-time":"2018-09-23T00:00:00Z","timestamp":1537660800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"funder":[{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["I50HX001240"],"award-info":[{"award-number":["I50HX001240"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["IIR 12\u2010084"],"award-info":[{"award-number":["IIR 12\u2010084"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["IK2HX000860"],"award-info":[{"award-number":["IK2HX000860"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["SDR 02\u2010237"],"award-info":[{"award-number":["SDR 02\u2010237"]}],"id":[{"id":"10.13039\/100007217","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/100007217","name":"Health Services Research and Development","doi-asserted-by":"publisher","award":["98.004"],"award-info":[{"award-number":["98.004"]}],"id":[{"id":"10.13039\/100007217","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":[[2018,12]]},"abstract":"<jats:sec><jats:title>Objective<\/jats:title><jats:p>To estimate health care utilization and costs incurred by homeless Veterans relative to nonhomeless Veterans and to examine the impact of a <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> homelessness program on these outcomes.<\/jats:p><\/jats:sec><jats:sec><jats:title>Data Sources\/Study Setting<\/jats:title><jats:p>Combined Department of Veterans Affairs (<jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content>) administrative and Medicare claims data.<\/jats:p><\/jats:sec><jats:sec><jats:title>Study Design<\/jats:title><jats:p>Observational study using longitudinal data from Veterans engaged with the <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> system and enrolled in Medicare. Veterans with administrative evidence of homelessness at any point during 2006\u20132010 were matched on period of military service to Veterans with no evidence of homelessness.<\/jats:p><\/jats:sec><jats:sec><jats:title>Principal Findings<\/jats:title><jats:p>Experience of homelessness was associated with 1.37 (95 percent <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.34\u20131.40) and 0.16 (95 percent <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a00.14\u20130.17) more outpatient encounters per quarter in <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> and non\u2010<jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> settings, respectively, and 1.31 (95 percent <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a01.30\u20131.32) and 0.49 (95 percent <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a00.48\u20130.49) more inpatient days per quarter in <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> and non\u2010<jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> hospitals, respectively. These were associated with higher costs. Relative to stably housed Veterans less than 65\u00a0years of age, those enrolled in a <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> homelessness program had 94.4 percent (95 percent <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a090.7 percent\u201398.1 percent) more <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> outpatient visits but 5.5 percent (95 percent <jats:styled-content style=\"fixed-case\">CI<\/jats:styled-content>\u00a0=\u00a03.0 percent\u20137.9 percent) fewer Medicare outpatient visits.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>Homelessness was associated with an increase in <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> and Medicare utilization and cost. A <jats:styled-content style=\"fixed-case\">VA<\/jats:styled-content> homelessness program decreased use of Medicare outpatient services.<\/jats:p><\/jats:sec>","DOI":"10.1111\/1475-6773.13054","type":"journal-article","created":{"date-parts":[[2018,9,24]],"date-time":"2018-09-24T01:07:21Z","timestamp":1537751241000},"page":"5352-5374","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":18,"title":["Costs Associated with Health Care Services Accessed through <scp>VA<\/scp> and in the Community through Medicare for Veterans Experiencing Homelessness"],"prefix":"10.1111","volume":"53","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4441-7460","authenticated-orcid":false,"given":"Richard E.","family":"Nelson","sequence":"first","affiliation":[{"name":"VA Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Suo","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Warren","family":"Pettey","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3013-1362","authenticated-orcid":false,"given":"Megan","family":"Vanneman","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"},{"name":"Department of Population Health Sciences University of Utah School of Medicine Salt Lake City UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ann Elizabeth","family":"Montgomery","sequence":"additional","affiliation":[{"name":"National Center on Homelessness Among Veterans Philadelphia PA"},{"name":"School of Public Health University of Alabama at Birmingham Birmingham AL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4824-0284","authenticated-orcid":false,"given":"Thomas","family":"Byrne","sequence":"additional","affiliation":[{"name":"National Center on Homelessness Among Veterans Philadelphia PA"},{"name":"School of Social Work Boston University Boston MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamison D.","family":"Fargo","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System Salt Lake City UT"},{"name":"National Center on Homelessness Among Veterans Philadelphia PA"},{"name":"Department of Psychology Utah State University Logan UT"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adi V.","family":"Gundlapalli","sequence":"additional","affiliation":[{"name":"VA Salt Lake City Health Care System Salt Lake City UT"},{"name":"Department of Internal Medicine University of Utah School of Medicine Salt Lake City UT"},{"name":"National Center on Homelessness Among Veterans Philadelphia PA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2018,9,23]]},"reference":[{"key":"e_1_2_6_2_1","doi-asserted-by":"publisher","DOI":"10.1186\/1471-2458-13-577"},{"key":"e_1_2_6_3_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2009.180109"},{"key":"e_1_2_6_4_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1475-6773.2011.01350.x"},{"key":"e_1_2_6_5_1","doi-asserted-by":"publisher","DOI":"10.7748\/ns2000.05.14.34.43.c2603"},{"key":"e_1_2_6_6_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11524-016-0110-5"},{"key":"e_1_2_6_7_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.nmd.0000252313.49043.f2"},{"key":"e_1_2_6_8_1","doi-asserted-by":"publisher","DOI":"10.1097\/00005650-199912000-00011"},{"key":"e_1_2_6_9_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475-6773.12612"},{"key":"e_1_2_6_10_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(14)61132-6"},{"key":"e_1_2_6_11_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2014.0054"},{"key":"e_1_2_6_12_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jclinepi.2010.10.004"},{"issue":"6","key":"e_1_2_6_13_1","first-page":"1273","article-title":"The Behavioral Model for Vulnerable Populations: Application to Medical Care Use and Outcomes for Homeless People","volume":"34","author":"Gelberg L.","year":"2000","journal-title":"Health Services Research"},{"key":"e_1_2_6_14_1","doi-asserted-by":"publisher","DOI":"10.2307\/3097746"},{"key":"e_1_2_6_15_1","doi-asserted-by":"publisher","DOI":"10.1300\/J013v40n02_06"},{"key":"e_1_2_6_16_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2015.8207"},{"key":"e_1_2_6_17_1","doi-asserted-by":"publisher","DOI":"10.1097\/MLR.0b013e318206c50d"},{"key":"e_1_2_6_18_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301369"},{"key":"e_1_2_6_19_1","doi-asserted-by":"publisher","DOI":"10.1097\/01.mlr.0000244657.90074.b7"},{"key":"e_1_2_6_20_1","doi-asserted-by":"publisher","DOI":"10.1089\/pop.2013.0118"},{"key":"e_1_2_6_21_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2005.0038"},{"key":"e_1_2_6_22_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.92.5.778"},{"key":"e_1_2_6_23_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1525-1497.2005.00278.x"},{"key":"e_1_2_6_24_1","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2009.414"},{"key":"e_1_2_6_25_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1553-2712.2000.tb02037.x"},{"key":"e_1_2_6_26_1","doi-asserted-by":"publisher","DOI":"10.7326\/0003-4819-116-4-299"},{"key":"e_1_2_6_27_1","doi-asserted-by":"publisher","DOI":"10.1097\/TA.0b013e318173f833"},{"key":"e_1_2_6_28_1","doi-asserted-by":"publisher","DOI":"10.1177\/003335491412900506"},{"key":"e_1_2_6_29_1","doi-asserted-by":"publisher","DOI":"10.1093\/ije\/dyp160"},{"key":"e_1_2_6_30_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0167-6296(98)00030-7"},{"key":"e_1_2_6_31_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jsat.2006.12.002"},{"key":"e_1_2_6_32_1","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pone.0132664"},{"key":"e_1_2_6_33_1","doi-asserted-by":"publisher","DOI":"10.1176\/appi.ps.201300104"},{"key":"e_1_2_6_34_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.0.0068"},{"key":"e_1_2_6_35_1","doi-asserted-by":"publisher","DOI":"10.1056\/NEJM199806113382406"},{"key":"e_1_2_6_36_1","doi-asserted-by":"publisher","DOI":"10.12927\/hcpol.2008.20012"},{"key":"e_1_2_6_37_1","doi-asserted-by":"publisher","DOI":"10.1023\/A:1015051610515"},{"key":"e_1_2_6_38_1","doi-asserted-by":"publisher","DOI":"10.2105\/AJPH.2013.301307"},{"key":"e_1_2_6_39_1","doi-asserted-by":"publisher","DOI":"10.7205\/MILMED-D-11-00128"},{"key":"e_1_2_6_40_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.ajem.2013.02.046"}],"container-title":["Health Services Research"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1111%2F1475-6773.13054","content-type":"application\/pdf","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/1475-6773.13054","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2023,9,13]],"date-time":"2023-09-13T04:43:11Z","timestamp":1694580191000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/1475-6773.13054"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2018,9,23]]},"references-count":39,"journal-issue":{"issue":"S3","published-print":{"date-parts":[[2018,12]]}},"alternative-id":["10.1111\/1475-6773.13054"],"URL":"https:\/\/doi.org\/10.1111\/1475-6773.13054","archive":["Portico"],"relation":{},"ISSN":["0017-9124","1475-6773"],"issn-type":[{"value":"0017-9124","type":"print"},{"value":"1475-6773","type":"electronic"}],"subject":[],"published":{"date-parts":[[2018,9,23]]},"assertion":[{"value":"2018-09-23","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}