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Principal Investigator: Eric Jutkowitz
Organization: PROVIDENCE VA MEDICAL CENTER
Fiscal Year: 2024
Funding agency: Veterans Affairs
Background: The US Department of Housing and Urban Development-Veterans Affairs Supportive Housing
(HUD-VASH) program offers permanent, subsidized independent housing and case management to over
60,000 Veterans annually. In response to COVID-19, HUD-VASH shifted case management from in-person to
telephone/video interactions. The goal of this project is to examine the effect of HUD-VASH’s shift to virtual
care on Veteran engagement and outcomes in the program. Our proposal is motivated by a working theory that
virtual care increased access to case management, primary care, and improved behavioral quality measures
conducive to phone/video interactions (e.g., follow-up after a psych hospitalization), but decreased access to
specialist care and worsened quality measures not conducive to phone/video interactions (e.g., meds for opioid
use disorder). Significance: The VA is dedicated to improving the housing and health of Veterans. Our project
will advance policy by helping the National Homeless Programs Office understand the impact of virtual care in
HUD-VASH to maximize program reach, engagement, and outcomes. The project addresses VA’s FY 2018-
2024 Strategic Objective 2.2 (“VA ensures at-risk and underserved Veterans receive what they need to
eliminate Veteran suicide, homelessness, and poverty”), objectives of RFA HX-21-025 (changes to virtual care
on Veteran outcomes), and objectives of HSR&D (virtual care and social determinants of health). Specific
Aims: Aim 1. Determine the effect of HUD-VASH’s shift to virtual care during the COVID-19 pandemic on case
management services: Hypothesis: HUD-VASH’s shift to virtual care during the pandemic resulted in more
total, telephone and video case management as compared to a pre-pandemic period. Secondary analysis:
Identify associations between Veteran factors (e.g., mental health diagnosis) with the use of case management
before and after the shift to virtual care, and Veteran factors associated with not engaging in any virtual care.
Aim 2. Evaluate the effect of HUD-VASH’s shift to virtual care during the pandemic on Veteran’s health care
utilization and continuity of care. Hypothesis: HUD-VASH’s shift to virtual care during the pandemic increased
the use of primary care and improved some behavioral quality measures while decreased other behavioral
quality measures not conducive to virtual care and the use of outpatient specialist care. Secondary analysis:
Examine Veteran factors associated with HUD-VASH program exits and utilization of health care in the year
after program exit. Aim 3. Examine Veteran and provider experiences with virtual case management in HUD-
VASH. Semi-structured interviews with VA leadership, case managers, and Veterans who experienced HUD-
VASH’s shift to virtual care, will provide an understanding of the barriers to and facilitators of the
implementation of virtual case management. Methodology: A convergent parallel mixed-methods design will
be used. Data from the VA’s Corporate Data Warehouse (CDW) will be linked with Homeless Operations
Management and Evaluation System (HOMES) for analysis. Using these data, Aims 1 and 2 will use an
interrupted time series design with segmented regression to examine utilization outcomes before and after
HUD-VASH’s shift to virtual care. For Aim 3, qualitative interviews with VA leadership, case managers and
Veterans will capture the experience of implementing and receiving virtual care and give context to our
quantitative findings. Next Steps/ Implementation: Our findings will inform the evolution of virtual care within
the HUD-VASH program. This project will also inform the Homeless Programs Office of the impact and
experience of transitioning to virtual care during the pandemic and the extent this transition and pandemic
disrupted VA care of homeless Veterans.
Terms: <Access to Care><Active Follow-up><Address><Adopted><Alcohol abuse><Ambulatory Care><Behavioral><COVID crisis><COVID epidemic><COVID pandemic><COVID-19><COVID-19 affected><COVID-19 consequence><COVID-19 crisis><COVID-19 effect><COVID-19 epidemic><COVID-19 era><COVID-19 global health crisis><COVID-19 global pandemic><COVID-19 health crisis><COVID-19 impact><COVID-19 impacted><COVID-19 pandemic><COVID-19 period><COVID-19 public health crisis><COVID-19 years><CV-19><Care Manager><Caring><Case Management><Case Manager><Clinical Services><Communities><Complex><Continuity of Care><Continuity of Patient Care><Continuum of Care><Coronavirus Infectious Disease 2019><Data><Dedications><Diagnosis><Drugs><Enrollment><Ensure><EtOH abuse><Evaluation><Evolution><Future><Goals><Health><Health Care Utilization><Health Services Accessibility><Healthcare><Home><Homelessness><Hospital Admission><Hospitalization><Housing><Housing and Urban Development><Impoverished><Interruption><Interview><Investments><Joints><Leadership><Link><Measures><Medical><Medical center><Medication><Mental Health><Mental Hygiene><Methodology><Methods><Modeling><Opioid Analgesics><Out-patients><Outcome><Outpatient Care><Outpatients><Persons><Pharmaceutical Preparations><Phone><Policies><Poverty><Primary Care><Provider><Psychological Health><Risk><SARS-CoV-2 epidemic><SARS-CoV-2 global health crisis><SARS-CoV-2 global pandemic><SARS-CoV-2 pandemic><SARS-coronavirus-2 epidemic><SARS-coronavirus-2 pandemic><Series><Services><Severe Acute Respiratory Syndrome CoV 2 epidemic><Severe Acute Respiratory Syndrome CoV 2 pandemic><Severe acute respiratory syndrome coronavirus 2 epidemic><Severe acute respiratory syndrome coronavirus 2 pandemic><Specialist><Structure><Suicide><System><Systems Analyses><Systems Analysis><Telephone><Time><U.S. Department of Housing and Urban Development><United States Department of Veterans Affairs><United States Veterans Administration><Veterans><Veterans Administration><Veterans Affairs><access to health services><access to services><access to treatment><accessibility to health services><active followup><alcohol co-abuse><alcohol problem><availability of services><behavioral health><care access><clinical care><coronavirus disease 2019><coronavirus disease 2019 consequence><coronavirus disease 2019 crisis><coronavirus disease 2019 effect><coronavirus disease 2019 epidemic><coronavirus disease 2019 global health crisis><coronavirus disease 2019 global pandemic><coronavirus disease 2019 health crisis><coronavirus disease 2019 impact><coronavirus disease 2019 pandemic><coronavirus disease 2019 public health crisis><coronavirus disease crisis><coronavirus disease epidemic><coronavirus disease pandemic><coronavirus disease-19><coronavirus disease-19 global pandemic><coronavirus disease-19 impact><coronavirus disease-19 pandemic><coronavirus infectious disease-19><data warehouse><design><designing><drug/agent><enroll><ethanol abuse><evidence base><experience><facilitators to implementation><fatal attempt><fatal suicide><follow up><follow-up><followed up><followup><hazardous alcohol use><health care><health care service use><health care service utilization><health service access><health services availability><healthcare service use><healthcare service utilization><healthcare utilization><homeless><homes><implementation facilitators><improved><inpatient psychiatric care><inpatient psychiatric treatment><intent to die><operation><operations><opiate analgesia><opiate analgesic><opiate pain medication><opiate pain reliever><opiate use disorder><opioid analgesia><opioid anesthetic><opioid pain medication><opioid pain reliever><opioid painkiller><opioid use disorder><outpatient treatment><outreach><pandemic><pandemic caused disruption><pandemic created disruption><pandemic disease><pandemic disruption><pandemic induced disruption><pandemic related disruption><pre-pandemic><problem alcohol use><problem drinking><problematic alcohol consumption><problematic alcohol use><programs><psychiatric hospitalization><public health emergency><response><secondary analysis><service availability><severe acute respiratory syndrome coronavirus 2 global health crisis><severe acute respiratory syndrome coronavirus 2 global pandemic><social health determinants><suicides><supported housing><supportive housing><theories><treatment access><unhoused><virtual><virtual care><virtual health care><virtual healthcare>