Measuring the impact of the Supportive Services for Veteran Families (SSVF) on Veteran outcomes

衡量退伍军人家庭支持服务 (SSVF) 对退伍军人成果的影响

• 批准号: 9913993
• 负责人: Richard E. Nelson
• 金额: --
• 依托单位: VA SALT LAKE CITY HEALTHCARE SYSTEM
• 依托单位国家: 美国
• 财政年份: 2019
• 资助国家: 美国
• 起止时间: 2019-02-01 至 2023-01-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9913993
• 关键词: Accident and Emergency department; Address; Attitude; Caring; Characteristics; Cohort Analysis; Communities; Country; Data; Economics; Effectiveness; Employee; Enrollment; Expenditure; Family; Financial Support; Geographic Locations; Goals; Health; Health Care Costs; Healthcare Systems; Heterogeneity; Homelessness; Housing; Individual; Inpatients; Intervention; Interview; Investments; Literature; Management Information Systems; Measures; Methodology; Methods; Modeling; Nonprofit Organizations; Outcome; Outpatients; Paper; Participant; Personal Satisfaction; Population; Privatization; Problem Solving; Program Evaluation; Program Sustainability; Publishing; Quality-Adjusted Life Years; Reporting; Research; Resources; Retrospective cohort; Risk; Service provision; Services; Site; Societies; Source; Structure; Suicide; Suicide prevention; Variant; Veterans; Work; cost; cost effective; cost outcomes; economic evaluation; experience; geographic difference; health care service utilization; health economics; housing instability; implementation strategy; improved; improved outcome; innovation; insight; models and simulation; mortality; mortality risk; operation; programs; satisfaction; service providers; structured data; treatment as usual; unstructured data

Background Through the Supportive Services for Veteran Families (SSVF) program, Veterans and their families who are experiencing homelessness or at risk of becoming homeless can receive of financial support and other services from private non-profit organizations with the goal of stabilizing their housing. The impact on Veteran housing, healthcare cost, and health outcomes as well as Veteran satisfaction with this program is not known. Specific aims Aim 1: Describe geographic variation in the amount of SSVF services provided and identify predictors of this variation for SSVF recipients for FY2012-FY2017 using data from the HMIS. Aim 2: Perform an outcome and economic assessment of the SSVF program. 2a: Measure the impact of the rapid re-housing component of SSVF on housing, health, and healthcare cost outcomes through retrospective cohort analyses for FY2012-FY2017. 2b: Conduct grantee-specific and overall economic evaluations of the SSVF program compared to usual care using input parameters from the published literature and from Aims 1 and 2a. Aim 3: Identify barriers and facilitators to SSVF use and Veterans' satisfaction with the program using semi- structured interviews with VA operations partners, SSVF grantee employees, VA homeless services providers, and Veterans using SSVF services. Significance of the proposed research and relevance to Veterans' health The loss of stable housing has a devastating effect on Veterans' health and well-being. In addition, homelessness can be costly both to the healthcare system and society as a whole. Solving the problem of Veteran homelessness is one of the most important initiatives the VA is currently pursuing. Unique features and innovation of the project Our study – comprising over 400 sites within the US – will be by far the largest study of a homeless intervention ever conducted in the US. In addition, we will use both structured and unstructured data and detailed, Veteran-level data on services and financial assistance received by Veterans enrolled in this program. Methodology to be used In Aim 1 we will construct multi-level regression models to identify both individual- and community-level predictors of SSVF services and expenditures. In Aim 2a, we will fit outcome models relating SSVF program initiation to the subsequent mortality, exit from homelessness, and cost outcomes in weighted populations defined by propensity scores. In Aim 2b, we will construct simulation models using input parameters from a variety of sources. And in Aim 3, we will conduct interviews with national VA stakeholders, SSVF grantee employees, VA homeless service providers, and Veterans who have enrolled in the SSVF program. Expected results In Aim 1, we expect to find considerable variation in services and expenditures across the country, which will be explained by observable Veteran- and community-level characteristics. We anticipate that our Aim 2a analyses will find that enrollment in SSVF will lead to increased rates of stable housing, lower mortality rates, and greater outpatient healthcare costs but lower emergency department and inpatient costs. in Aim 2b, our hypothesis is that the SSVF program will be cost-effective overall and yield a positive return on investment compared to usual care but these effects will vary substantially across SSVF sites. Finally, our qualitative data from Aim 3 will provide insight into ways to improve the SSVF program, enhance implementation strategies, and explore the experience of Veterans with housing instability.

背景 通过退伍军人家庭支持服务(SSVF)计划，退伍军人及其家人 经历无家可归或面临无家可归风险的人可以获得经济支持和其他 私人非营利组织提供的服务，目的是稳定他们的住房。对退伍军人的影响 住房、医疗成本、健康结果以及退伍军人对该计划的满意度尚不清楚。 具体目标 目标1：描述所提供的SSVF服务数量的地理差异，并确定预测因素 使用卫生管理信息系统的数据对2012-2017财年SSVF受助人的变化。 目标2：对SSVF方案进行成果和经济评估。 2A：衡量SSVF快速安置部分对住房、健康和医疗保健成本的影响 通过对2012-2017财年的回顾队列分析得出的结果。 2B：与通常护理相比，对SSVF方案进行受赠人具体和总体经济评估 使用来自已发表文献以及来自目标1和2a的输入参数。 目标3：确定使用SSVF的障碍和促进者，以及退伍军人对该计划的满意度 对退伍军人管理局运营合作伙伴、SSVF受赠员工、退伍军人无家可归者服务提供者、 以及使用SSVF服务的退伍军人。 拟议研究的意义及其与退伍军人健康的相关性 失去稳定的住房对退伍军人的健康和福祉产生了毁灭性的影响。此外, 无家可归对医疗系统和整个社会来说都可能是代价高昂的。解决的问题是 退伍军人无家可归是退伍军人管理局目前正在推行的最重要的倡议之一。 项目的特色和创新 我们的研究--包括美国境内的400多个地点--将是迄今为止对无家可归者进行的最大规模的研究 美国从未进行过的干预。此外，我们将同时使用结构化和非结构化数据以及 关于参加该计划的退伍军人获得的服务和财政援助的详细退伍军人级别数据。 应使用的方法 在目标1中，我们将构建多水平回归模型，以确定个人和社区水平 SSVF服务和支出的预测者。在目标2a中，我们将拟合与SSVF计划相关的结果模型 加权人群的后续死亡率、脱离无家可归和成本结果的开始 由倾向分数来定义。在目标2b中，我们将使用来自 来源多种多样。在目标3中，我们将与国家退伍军人管理局利益相关者、SSVF受赠者进行访谈 雇员、退伍军人无家可归服务提供者和已登记参加SSVF计划的退伍军人。 预期结果 在目标1中，我们预计全国各地的服务和支出将有相当大的差异，这将 由可观察到的退伍军人和社区特征来解释。我们预计我们的目标是2a 分析将发现，参加SSVF将导致稳定住房比率的增加，死亡率的降低， 以及更高的门诊医疗成本，但降低了急诊科和住院成本。在Aim 2b中，我们的 假设SSVF计划总体上具有成本效益，并产生正的投资回报 与通常的护理相比，但这些影响在SSVF地点将有很大差异。最后，我们的定性数据 目标3将提供关于如何改进SSVF方案、增强实施战略、 并探索住房不稳定退伍军人的经验。