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McInnes D.K.,Center for Healthcare Organization and Implementation Research | Petrakis B.A.,Center for Healthcare Organization and Implementation Research | Gifford A.L.,Center for Healthcare Organization and Implementation Research | Rao S.R.,Center for Healthcare Organization and Implementation Research | And 3 more authors.
American Journal of Public Health | Year: 2014

Objectives. We examined the feasibility of using mobile phone text messaging with homeless veterans to increase their engagement in care and reduce appointment no-shows. Methods.We sent 2 text message reminders to participants (n = 20) before each of their outpatient appointments at an urban Veterans Affairs medical center. Evaluation included pre- and postsurvey questionnaires, open-ended questions, and review of medical records. We estimated costs and savings of large-scale implementation. Results. Participants were satisfied with the text-messaging intervention, had very few technical difficulties, and were interested in continuing. Patientcancelled visits and no-shows trended downward from 53 to 37 and from 31 to 25, respectively. Participants also experienced a statistically significant reduction in emergency department visits, from 15 to 5 (difference of 10; 95% confidence interval [CI] = 2.2, 17.8; P = .01), and a borderline significant reduction in hospitalizations, from 3 to 0 (difference of 3; 95% CI =-0.4, 6.4; P = .08). Conclusions. Text message reminders are a feasible means of reaching homeless veterans, and users consider it acceptable and useful. Implementation may reduce missed visits and emergency department use, and thus produce substantial cost savings.

Fargo J.,Utah State University | Metraux S.,University of the Sciences in Philadelphia | Byrne T.,University of Pennsylvania | Montgomery A.E.,University of Pennsylvania | And 4 more authors.
Preventing Chronic Disease | Year: 2012

Introduction: Understanding the prevalence of and risk for homelessness among veterans is prerequisite to preventing and ending homelessness among this population. Homeless veterans are at higher risk for chronic disease; understanding the dynamics of homelessness among veterans can contribute to our understanding of their health needs. Methods: We obtained data on demographic characteristics and veteran status for 130,554 homeless people from 7 jurisdictions that provide homelessness services, and for the population living in poverty and the general population from the American Community Survey for those same jurisdictions. We calculated prevalence of veterans in the homeless, poverty, and general populations, and risk ratios (RR) for veteran status in these populations. Risk for homelessness, as a function of demographic characteristics and veteran status, was estimated by using multivariate regression models. Results: Veterans were overrepresented in the homeless population, compared with both the general and poverty populations, among both men (RR, 1.3 and 2.1, respectively) and women (RR, 2.1 and 3.0, respectively). Veteran status and black race significantly increased the risk for homelessness for both men and women. Men in the 45- to 54-year-old age group and women in the 18- to 29-year-old age group were at higher risk compared with other ages. Conclusion: Our findings confirm previous research associating veteran status with higher risk for homelessness and imply that there will be specific health needs among the aging homeless population. This study is a basis for understanding variation in rates of, and risks for, homelessness in general population groups, and inclusion of health data from US Department of Veterans Affairs records can extend these results to identifying links between homelessness and health risks.

Montgomery A.E.,National Center on Homelessness among Veterans | Dichter M.E.,Center for Health Equity Research and Promotion | Thomasson A.M.,Center for Health Equity Research and Promotion | Fu X.,Center for Health Equity Research and Promotion | Roberts C.B.,Center for Health Equity Research and Promotion
Women's Health Issues | Year: 2015

Background: This study explored demographic influences on veterans' reports of homelessness or imminent risk of homelessness with a particular focus on gender. Methods: We analyzed data for a cohort of veterans who responded to the U.S. Department of Veterans Affairs (VA), Veterans Health Administration (VHA) universal screener for homelessness and risk during a 3-month period. Multinomial mixed effects models-stratified by gender-predicted veterans' reports of homelessness or risk based on age, race, marital status, and receipt of VA compensation. Findings: The proportion of positive screens-homelessness or risk-was 2.7% for females and 1.7% for males. Women more likely to report being at risk of homelessness were aged 35 to 54years, Black, and unmarried; those more likely to experience homelessness were Black and unmarried. Among male veterans, the greatest predictors of both homelessness and risk were Black race and unmarried status. Among both genders, receiving VA disability compensation was associated with lesser odds of being homeless or at risk. Conclusions: The findings describe the current population of veterans using VHA health care services who may benefit from homelessness prevention or intervention services, identify racial differences in housing stability, and distinguish subpopulations who may be in particular need of intervention. Interventions to address these needs are described. © 2015 .

Byrne T.,University of Pennsylvania | Montgomery A.E.,National Center on Homelessness among Veterans | Dichter M.E.,Center for Health Equity Research and Promotion
Women and Health | Year: 2013

The authors conducted a systematic, critical review of the literature to assess and summarize existing research on homelessness among female veterans. They searched seven electronic databases (ERIC, Proquest Dissertations and Theses, PsycINFO, PubMed, Social Services Abstracts, Social Science Citation Index, and Sociological Abstracts), websites of several government and research organizations, and reference lists of prior studies. They abstracted data on study design, funding source, and topic from studies meeting inclusion criteria and classified each study into one of the following categories: epidemiology, health and other services utilization, and interventions. The authors included both experimental and observational studies of interventions in the review and performed a narrative synthesis for each of the 26 studies identified. No studies were experimental, 20 were observational, and the remainder were either qualitative or descriptive. Of the 26 identified studies, 14 were epidemiologic, 7 focused on the health and additional service utilization, and 5 were intervention studies. Findings provided important baseline epidemiologic information about homelessness among female veterans and indicated that female veterans were at an increased risk of homelessness relative to their male veteran and female non-veteran counterparts. Additional research is needed to develop and implement effective, evidence-based programs to prevent and end homelessness among women veterans. The contents of this article do not necessarily represent the views of the Department of Veterans Affairs or the United States Government. © 2013 Taylor and Francis Group, LLC.

Montgomery A.E.,National Center on Homelessness among Veterans | Fargo J.D.,National Center on Homelessness among Veterans | Fargo J.D.,Utah State University | Kane V.,National Center on Homelessness among Veterans | And 2 more authors.
Public Health Reports | Year: 2014

Objectives. Veterans are overrepresented within the homeless population compared with their non-veteran counterparts, particularly when controlling for poverty. The U.S. Department of Veterans Affairs (VA) aims to prevent new episodes of homelessness by targeting households at greatest risk; however, there are no instruments that systematically assess veterans' risk of homelessness. We developed and tested a brief screening instrument to identify imminent risk of homelessness among veterans accessing VA health care. Methods. The study team developed initial assessment items, conducted cognitive interviews with veterans experiencing homelessness, refined pilot items based on veterans' and experts' feedback and results of psychometric analyses, and assigned weights to items in the final instrument to indicate a measure of homelessness risk. Results. One-third of veterans who responded to the field instrument reported imminent risk of homelessness (i.e., housing instability in the previous 90 days or expected in the next 90 days). The reliability coefficient for the instrument was 0.85, indicating good internal consistency. Veterans who had a recent change in income, had unpaid housing expenses, were living temporarily with family and friends, needed help to get or keep housing, and had poor rental and credit histories were more likely to report a risk of homelessness than those who did not. Conclusion. This study provides the field with an instrument to identify individuals and households at risk of or experiencing homelessness, which is necessary to prevent and end homelessness. In addition, it supports VA's investment in homelessness prevention and rapid rehousing services for veterans who are experiencing or are at risk for homelessness.

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