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Screening for Housing Instability: Providers’ Reflections on Addressing a Social Determinant of Health

  • Manik Chhabra
  • Anneliese E. Sorrentino
  • Meagan Cusack
  • Melissa E. Dichter
  • Ann Elizabeth MontgomeryEmail author
  • Gala True
Original Research

Abstract

Background

The Veterans Health Administration (VHA) has a long history of addressing social determinants of health, including housing. In 2012, the VA integrated a two-question Homelessness Screening Clinical Reminder (HSCR) into the electronic medical record in outpatient clinics to identify Veterans experiencing housing instability and ensure referral to appropriate services.

Objective

This study explores perspectives of VA clinical providers regarding administration of the HSCR, their role in addressing housing status, and how a patient’s housing status impacts clinical decision-making.

Design

We conducted a qualitative study using in-depth semi-structured interviewing.

Participants

Twenty-two providers were interviewed (20 physicians and two nurse practitioners) between March and September 2016.

Approach

Interviews were conducted with Veterans Health Administration (VHA) physician and non-physician practitioners who had administered the HSCR and documented at least five positive screens between 2013 and 2015. Our interview guide investigated provider experiences with administering the HSCR and addressing affirmative responses. The guide also elicited details about how patients’ housing instability was identified (if at all) prior to implementation of the screening reminder, and how practices changed following implementation of the HSCR. Transcripts were analyzed using a modified grounded theory approach.

Key Results

Providers reported that the HSCR prompted them to incorporate patient housing status into routine assessment, which they typically did not do prior to its implementation. Providers discussed adverse impacts of housing instability on patients’ overall health and described how they factored patients’ housing instability into clinical decision-making. Although providers viewed the health system as having an important role in addressing housing concerns, there were mixed opinions on whether it was the role of providers to directly administer the screening.

Conclusions

Integration of a screener for housing instability into the electronic medical record increased provider attention to housing instability into the social history, and positive responses commonly impacted plans of care.

KEY WORDS

homelessness social determinants of health screening qualitative research Veterans 

Notes

Funding Information

This work was supported by the US Department of Veterans Affairs, Health Services Research and Development under Grant IIR-13-334 (Montgomery).

Compliance with Ethical Standards

The study was conducted at the Corporal Michael J. Crescenz VA Medical Center (CMCVAMC) in Philadelphia, PA, or an associated community-based outpatient clinic (CBOC), and was approved by the CMCVAMC Institutional Review Board.

Conflict of Interest

The authors declare that they do not have a conflict of interest.

Disclaimer

The views expressed here do not necessarily reflect those of the Department of Veterans Affairs or the United States Government.

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Copyright information

© Society of General Internal Medicine 2019

Authors and Affiliations

  • Manik Chhabra
    • 1
  • Anneliese E. Sorrentino
    • 2
  • Meagan Cusack
    • 2
  • Melissa E. Dichter
    • 2
    • 3
  • Ann Elizabeth Montgomery
    • 4
    • 5
    • 6
    Email author
  • Gala True
    • 7
    • 8
  1. 1.U.S. Department of Veterans Affairs, Department of Medicine at the Cpl. Michael Crescenz VA Medical CenterPhiladelphiaUSA
  2. 2.U.S. Department of Veterans Affairs, Center for Health Equity Research and PromotionPhiladelphiaUSA
  3. 3.University of Pennsylvania, Perelman School of MedicinePhiladelphiaUSA
  4. 4.U.S. Department of Veterans Affairs, National Center on Homelessness Among VeteransPhiladelphiaUSA
  5. 5.School of Public HealthUniversity of Alabama at BirminghamBirminghamUSA
  6. 6.Health Services Research & Development, Mail Stop 151(A) – Pickwick CenterBirmingham VA Medical CenterBirminghamUSA
  7. 7.U.S. Department of Veterans Affairs, South Central Mental Illness, Research, Education and Clinical CenterNew OrleansUSA
  8. 8.School of MedicineLouisiana State UniversityNew OrleansUSA

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