{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,31]],"date-time":"2026-10-31T00:01:08Z","timestamp":1793404868781,"version":"4.5.0"},"reference-count":19,"publisher":"Public Library of Science (PLoS)","issue":"12","license":[{"start":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T00:00:00Z","timestamp":1672358400000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/publicdomain\/zero\/1.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:p>The main objective of this study was to examine how homelessness and housing instability is captured across data sources in the Veterans Health Administration (VHA). Data from 2021 were extracted from three data repositories, including the Corporate Data Warehouse (CDW), the Homeless Operations Management System (HOMES), and the Homeless Management Information System (HMIS). Using these three data sources, we identified the number of homeless and unstably housed veterans across a variety of indicators. The results showed that the use of diagnostic codes and clinic stop codes identified a large number of homeless and unstably housed veterans, but the use of HOMES and HMIS data identified additional homeless and unstably housed veterans to provide a complete count. A total of 290,431 unique veterans were identified as experiencing homelessness or housing instability in 2021 and there was regional variability in how homelessness and housing stability were captured across data sources, supporting the need for more uniform ways to operationalize these conditions. Together, these findings highlight the and encourage use of all available indicators and data sources to identify homelessness and housing instability in VHA. These methodologies applied to the largest healthcare system in the U.S. demonstrate their utility and possibilities for other healthcare systems. Transparent practices about data sources and indicators used to capture homelessness and housing instability should be shared to increase uniform use.<\/jats:p>","DOI":"10.1371\/journal.pone.0279973","type":"journal-article","created":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T19:01:34Z","timestamp":1672426894000},"page":"e0279973","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":70,"title":["Developing an operational definition of housing instability and homelessness in Veterans Health Administration\u2019s medical records"],"prefix":"10.1371","volume":"17","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-0329-648X","authenticated-orcid":true,"given":"Jack","family":"Tsai","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dorota","family":"Szymkowiak","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1735-8434","authenticated-orcid":true,"given":"Eric","family":"Jutkowitz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2022,12,30]]},"reference":[{"issue":"6","key":"pone.0279973.ref001","doi-asserted-by":"crossref","first-page":"2119","DOI":"10.1007\/s13524-018-0717-0","article-title":"Racial and ethnic disparities in the lifetime prevalence of homelessness in the United States","volume":"55","author":"VA Fusaro","year":"2018","journal-title":"Demography"},{"issue":"1","key":"pone.0279973.ref002","doi-asserted-by":"crossref","first-page":"65","DOI":"10.1093\/pubmed\/fdx034","article-title":"Lifetime and 1-year prevalence of homelessness in the U.S. population: Results from the National Epidemiologic Survey on Alcohol and Related Conditions-III","volume":"40","author":"J Tsai","year":"2018","journal-title":"Journal of Public Health"},{"key":"pone.0279973.ref003","volume-title":"Abt Associates. The 2020 Annual Homeless Assessment Report (AHAR) to Congress","author":"M Henry","year":"2021"},{"issue":"3","key":"pone.0279973.ref004","doi-asserted-by":"crossref","first-page":"877","DOI":"10.1093\/ije\/dyp160","article-title":"Homelessness as an independent risk factor for mortality: Results from a retrospective cohort study","volume":"38","author":"DS Morrison","year":"2009","journal-title":"International Journal of Epidemiology"},{"issue":"685","key":"pone.0279973.ref005","doi-asserted-by":"crossref","first-page":"e515","DOI":"10.3399\/bjgp19X704609","article-title":"Multimorbidity and emergency department visits by a homeless population: A database study in specialist general practice","volume":"69","author":"M Bowen","year":"2019","journal-title":"British Journal of General Practice"},{"issue":"Suppl2","key":"pone.0279973.ref006","doi-asserted-by":"crossref","first-page":"S225","DOI":"10.2105\/AJPH.2013.301307","article-title":"When health insurance is not a factor: National comparison of homeless and nonhomeless US veterans who use Veterans Affairs emergency departments","volume":"103","author":"J Tsai","year":"2013","journal-title":"American Journal of Public Health"},{"issue":"11","key":"pone.0279973.ref007","doi-asserted-by":"crossref","first-page":"2109","DOI":"10.1377\/hlthaff.2016.0727","article-title":"Housing, transportation, and food: how ACOs seek to improve population health by addressing nonmedical needs of patients","volume":"35","author":"T Fraze","year":"2016","journal-title":"Health Affairs"},{"key":"pone.0279973.ref008","volume-title":"About Homeless Programs","author":"U.S. Department of Veterans Affairs","year":"2019"},{"issue":"1","key":"pone.0279973.ref009","doi-asserted-by":"crossref","first-page":"145","DOI":"10.1007\/s10742-020-00225-5","article-title":"How do we define homelessness in large health care data? Identifying variation in composition and comorbidities","volume":"21","author":"WP Bensken","year":"2021","journal-title":"Health Services and Outcomes Research Methodology"},{"issue":"1","key":"pone.0279973.ref010","doi-asserted-by":"crossref","first-page":"177","DOI":"10.1093\/epirev\/mxu004","article-title":"Risk factors for homelessness among U.S. veterans","volume":"37","author":"J Tsai","year":"2015","journal-title":"Epidemiologic Reviews"},{"key":"pone.0279973.ref011","author":"U.S. Interagency Council on Homelessness","year":"2010"},{"key":"pone.0279973.ref012","volume-title":"Secretaries of HUD, VA joint statement on ending Veteran homelessness","author":"ML Fudge","year":"2021"},{"issue":"3","key":"pone.0279973.ref013","doi-asserted-by":"crossref","first-page":"682","DOI":"10.1093\/jamia\/ocu005","article-title":"Identifying homelessness using health information exchange data","volume":"22","author":"J Zech","year":"2015","journal-title":"Journal of the American Medical Informatics Association"},{"issue":"3","key":"pone.0279973.ref014","doi-asserted-by":"crossref","first-page":"1992","DOI":"10.1111\/1475-6773.12738","article-title":"Identifying homeless Medicaid enrollees using enrollment addresses","volume":"53","author":"KD Vickery","year":"2018","journal-title":"Health Services Research"},{"issue":"2","key":"pone.0279973.ref015","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1037\/ser0000116","article-title":"A national evaluation of homeless and nonhomeless veterans\u2019 experiences with primary care","volume":"14","author":"AL Jones","year":"2017","journal-title":"Psychological Services"},{"issue":"5","key":"pone.0279973.ref016","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1111\/j.1521-0391.2011.00166.x","article-title":"Association of substance use and VA service-connected disability benefits with risk of homelessness among veterans","volume":"20","author":"EL Edens","year":"2011","journal-title":"American Journal of Addictions"},{"issue":"7","key":"pone.0279973.ref017","doi-asserted-by":"crossref","first-page":"e0132664","DOI":"10.1371\/journal.pone.0132664","article-title":"Identifying homelessness among veterans using VA administrative data: opportunities to expand detection criteria","volume":"10","author":"R Peterson","year":"2015","journal-title":"PloS one"},{"issue":"11","key":"pone.0279973.ref018","first-page":"e32851","article-title":"Risk factors associated with nonfatal opioid overdose leading to intensive care unit admission: Cross-sectional study","volume":"9","author":"A Mitra","year":"2021","journal-title":"Journal of Medical Internet Research"},{"key":"pone.0279973.ref019","doi-asserted-by":"crossref","first-page":"103903","DOI":"10.1016\/j.jbi.2021.103903","article-title":"ReHouSED: A novel measurement of Veteran housing stability using natural language processing","volume":"122","author":"AB Chapman","year":"2021","journal-title":"Journal of Biomedical Informatics"}],"updated-by":[{"DOI":"10.1371\/journal.pone.0322834","type":"correction","label":"Correction","source":"publisher","updated":{"date-parts":[[2025,4,24]],"date-time":"2025-04-24T00:00:00Z","timestamp":1745452800000}}],"container-title":["PLOS ONE"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279973","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,12,30]],"date-time":"2022-12-30T19:01:49Z","timestamp":1672426909000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0279973"}},"subtitle":[],"editor":[{"given":"Sean A.","family":"Kidd","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2022,12,30]]},"references-count":19,"journal-issue":{"issue":"12","published-online":{"date-parts":[[2022,12,30]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0279973","relation":{"correction":[{"id-type":"doi","id":"10.1371\/journal.pone.0322834","asserted-by":"object"}]},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,12,30]]}}}