{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T13:02:38Z","timestamp":1789995758279,"version":"4.0.1"},"reference-count":32,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T00:00:00Z","timestamp":1779148800000},"content-version":"vor","delay-in-days":79,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2026,3,1]],"date-time":"2026-03-01T00:00:00Z","timestamp":1772323200000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["The Journal of Rural Health"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>This study examined whether the Supportive Services for Veteran Families (SSVF) program has a differential impact on healthcare utilization and costs among rural and urban Veterans experiencing housing instability. Understanding geographic variation in program effects is important for guiding implementation and resource allocation within the Veterans Affairs (VA) healthcare system.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We conducted a retrospective cohort study using national VA administrative data from October 1, 2018 to September 30, 2023. Veterans were classified as SSVF participants or eligible non\u2010SSVF Veterans based on indicators of housing instability. A target trial emulation framework with inverse probability weighting was used to adjust for baseline differences. Rurality was defined using Rural\u2013Urban Commuting Area codes applied to Veterans\u2019 residential addresses recorded in VA administrative data. Weighted longitudinal models estimated quarterly changes in healthcare utilization and costs and tested whether effects varied by rurality.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Findings<\/jats:title>\n                    <jats:p>SSVF enrollment was associated with reductions in inpatient utilization and costs and modest increases in outpatient visits, resulting in overall decreases in total VA healthcare costs. Emergency department use showed small reductions among urban Veterans and little measurable change among rural Veterans. Overall patterns of healthcare utilization and spending were similar across rural and urban Veterans, and statistical tests did not indicate significant rural\u2013urban differences in SSVF effects.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>SSVF participation was associated with shifts away from inpatient care and toward greater outpatient engagement among Veterans experiencing housing instability. These patterns were observed among both rural and urban Veterans, suggesting that the healthcare benefits of housing stabilization programs are similar across geographic settings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1111\/jrh.70167","type":"journal-article","created":{"date-parts":[[2026,5,19]],"date-time":"2026-05-19T09:13:13Z","timestamp":1779181993000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Differential Impact of the Supportive Services for Veteran Families (SSVF) Program on Veterans Affairs Healthcare Utilization and Costs Among Rural and Urban Veterans Experiencing Housing Instability"],"prefix":"10.1111","volume":"42","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9765-1197","authenticated-orcid":false,"given":"Minkyoung","family":"Yoo","sequence":"first","affiliation":[{"name":"US Department of Veterans Affairs IDEAS Center, Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alec B.","family":"Chapman","sequence":"additional","affiliation":[{"name":"US Department of Veterans Affairs IDEAS Center, Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Department of Population Health Sciences University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ying","family":"Suo","sequence":"additional","affiliation":[{"name":"US Department of Veterans Affairs IDEAS Center, Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Byrne","sequence":"additional","affiliation":[{"name":"Center for Healthcare Organization and Implementation Research VA Bedford Healthcare System  Bedford Massachusetts USA"},{"name":"Boston College School of Social Work  Chestnut Hill, Newton, Massachusetts USA"},{"name":"National Center on Homelessness among Veterans VA Homeless Programs Office  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4420-3526","authenticated-orcid":false,"given":"Ann E.","family":"Montgomery","sequence":"additional","affiliation":[{"name":"US Department of Veterans Affairs Birmingham VA Health Care System  Birmingham Alabama USA"},{"name":"School of Public Health University of Alabama at Birmingham  Birmingham Alabama USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Richard E.","family":"Nelson","sequence":"additional","affiliation":[{"name":"US Department of Veterans Affairs IDEAS Center, Salt Lake City Health Care System  Salt Lake City Utah USA"},{"name":"Department of Internal Medicine University of Utah School of Medicine  Salt Lake City Utah USA"},{"name":"National Center on Homelessness among Veterans VA Homeless Programs Office  Washington District of Columbia USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2026,5,19]]},"reference":[{"key":"e_1_2_10_2_1","volume-title":"VA Mental Health: Additional Action Needed to Assess Rural Veterans\u2019 Access to Intensive Care","author":"U.S. Government Accountability Office","year":"2016"},{"key":"e_1_2_10_3_1","doi-asserted-by":"publisher","DOI":"10.3390\/healthcare13030275"},{"key":"e_1_2_10_4_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11606\u2010011\u20101762\u20101"},{"key":"e_1_2_10_5_1","doi-asserted-by":"publisher","DOI":"10.1016\/s0277\u20109536(99)00414\u20101"},{"key":"e_1_2_10_6_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1748\u20100361.2006.00033.x"},{"key":"e_1_2_10_7_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.13054"},{"key":"e_1_2_10_8_1","unstructured":"K.Rieke C. E.Baltich B.Nelson et\u00a0al. \u201cEngaging Veterans Experiencing Homelessness in Primary Care: A Systematic Review \u201d VA ESP Project #22\u2010116 (Washington DC: Evidence Synthesis Program Health Systems Research Office of Research and Development Department of Veterans Affairs 2024)."},{"key":"e_1_2_10_9_1","doi-asserted-by":"publisher","DOI":"10.5888\/pcd15.170311"},{"key":"e_1_2_10_10_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamainternmed.2020.6288"},{"key":"e_1_2_10_11_1","unstructured":"U.S. Department of Veterans Affairs.\u00a0Supportive Services for Veteran Families (SSVF) Program Guide. Washingtong DC: U.S. Department of Veterans Affairs(2021). Accessed May 2024.https:\/\/department.va.gov\/homeless\/supportive\u2010services\u2010for\u2010veteran\u2010families\/."},{"key":"e_1_2_10_12_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2020.37047"},{"key":"e_1_2_10_13_1","doi-asserted-by":"publisher","DOI":"10.1377\/hlthaff.2023.00730"},{"key":"e_1_2_10_14_1","doi-asserted-by":"publisher","DOI":"10.1111\/1475\u20106773.14428"},{"key":"e_1_2_10_15_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamanetworkopen.2024.43396"},{"key":"e_1_2_10_16_1","doi-asserted-by":"publisher","DOI":"10.1353\/hpu.2022.0140"},{"key":"e_1_2_10_17_1","doi-asserted-by":"publisher","DOI":"10.1001\/jamahealthforum.2025.6417"},{"key":"e_1_2_10_18_1","volume-title":"Homeless Management Information System (HMIS) FY25 Data Standards Manual","author":"U.S. Department of Housing and Urban Development","year":"2025"},{"key":"e_1_2_10_19_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwv254"},{"key":"e_1_2_10_20_1","doi-asserted-by":"publisher","DOI":"10.1093\/biomet\/70.1.41"},{"key":"e_1_2_10_21_1","doi-asserted-by":"publisher","DOI":"10.1080\/10511482.2020.1716823"},{"key":"e_1_2_10_22_1","doi-asserted-by":"publisher","DOI":"10.1080\/00273171.2011.568786"},{"key":"e_1_2_10_23_1","doi-asserted-by":"publisher","DOI":"10.1097\/00001648\u2010200009000\u201000011"},{"key":"e_1_2_10_24_1","doi-asserted-by":"publisher","DOI":"10.1093\/aje\/kwn164"},{"key":"e_1_2_10_25_1","unstructured":"U.S. Department of Agriculture Economic Research Service \u201c2020 Rural\u2010Urban Commuting Area Codes \u201d (2025).https:\/\/www.ers.usda.gov\/data\u2010products\/rural\u2010urban\u2010commuting\u2010area\u2010codes."},{"key":"e_1_2_10_26_1","unstructured":"U.S. Bureau of Economic Analysis \u201cTable 2.3.4. 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