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

背景 通过退伍军人家庭支持服务（SSVF）计划，退伍军人及其家庭 无家可归或有可能无家可归的人可以获得经济支持和其他援助。 他们还可以利用私人非营利组织提供的服务，以稳定他们的住房。对退伍军人的影响 住房、医疗保健费用和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SSVF服务量的地理差异，并确定预测因素 使用HMIS的数据对2012 - 2017财年SSVF接受者的变化进行分析。 目标2：对SSVF计划进行结果和经济评估。 2a：衡量SSVF的快速重新安置部分对住房、健康和医疗保健成本的影响 通过回顾性队列分析得出2012 - 2017财年的结局。 2b：对SSVF计划与常规护理相比进行特定受资助者和总体经济评估 使用来自公开文献和目标1和2a的输入参数。 目标3：确定SSVF使用的障碍和促进因素，以及退伍军人对使用半自动化系统的计划的满意度。 与VA运营合作伙伴，SSVF受助员工，VA无家可归者服务提供者进行结构化访谈， 使用SSVF服务的退伍军人。 拟议研究的意义和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，本发明还提供了一种方法， 无家可归对保健系统和整个社会来说都是代价高昂的。问题的解决 退伍军人无家可归是退伍军人事务部目前正在推行的最重要的举措之一。 项目的独特性和创新性 我们的研究--包括美国400多个地点--将是迄今为止对无家可归者的最大研究。 在美国进行的干预。此外，我们将使用结构化和非结构化数据， 详细的，退伍军人一级的数据服务和财政援助收到的退伍军人参加了这一计划。 所用方法 在目标1中，我们将构建多层次回归模型，以确定个人和社区层面 SSVF服务和支出的预测因素。在目标2a中，我们将拟合与SSVF计划相关的结果模型 加权人群中的初始至随后死亡率、从无家可归中退出以及成本结果 由倾向分数定义。在目标2b中，我们将使用来自 各种来源。在目标3中，我们将与国家VA利益相关者、SSVF受资助者 雇员，退伍军人管理局无家可归的服务提供者，和退伍军人谁参加了SSVF计划。 预期结果 在目标1中，我们预计全国各地的服务和支出会有相当大的变化， 可以通过观察到的退伍军人和社区一级的特征来解释。我们预计，我们的目标2a 分析将发现，SSVF的入学将导致稳定住房率的增加，死亡率的降低， 门诊医疗费用增加，但急诊和住院费用降低。在目标2b，我们 一个假设是，SSVF计划总体上将是成本效益高的，并产生正的投资回报 但这些影响在SSVF部位之间差异很大。最后，我们的定性数据 目标3中提出的建议将深入探讨如何改进SSVF计划，加强实施战略， 探索退伍军人住房不稳定的经验。

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.