Developing an operational definition of housing instability and homelessness in Veterans Health Administration’s medical records

The main objective of this study was to examine how homelessness and housing instability is captured across data sources in the Veterans Health Administration (VHA). Data from 2021 were extracted from three data repositories, including the Corporate Data Warehouse (CDW), the Homeless Operations Management System (HOMES), and the Homeless Management Information System (HMIS). Using these three data sources, we identified the number of homeless and unstably housed veterans across a variety of indicators. The results showed that the use of diagnostic codes and clinic stop codes identified a large number of homeless and unstably housed veterans, but the use of HOMES and HMIS data identified additional homeless and unstably housed veterans to provide a complete count. A total of 290,431 unique veterans were identified as experiencing homelessness or housing instability in 2021 and there was regional variability in how homelessness and housing stability were captured across data sources, supporting the need for more uniform ways to operationalize these conditions. Together, these findings highlight the and encourage use of all available indicators and data sources to identify homelessness and housing instability in VHA. These methodologies applied to the largest healthcare system in the U.S. demonstrate their utility and possibilities for other healthcare systems. Transparent practices about data sources and indicators used to capture homelessness and housing instability should be shared to increase uniform use.