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Persistent Super-Utilization of Acute Care Services Among Subgroups of Veterans Experiencing Homelessness

Szymkowiak, Dorota PhD*; Montgomery, Ann Elizabeth PhD; Johnson, Erin E. BA; Manning, Todd BA§; O’Toole, Thomas P. MD

doi: 10.1097/MLR.0000000000000796
Original Article

Background: Acute health care utilization often occurs among persons experiencing homelessness. However, knowing which individuals will be persistent super-utilizers of acute care is less well understood.

Objective: The objective of the study was to identify those more likely to be persistent super-utilizers of acute care services.

Research Design: We conducted a latent class analysis of secondary data from the Veterans Health Administration Corporate Data Warehouse, and Homeless Operations Management and Evaluation System. The study sample included 16,912 veterans who experienced homelessness and met super-utilizer criteria in any quarter between July 1, 2014 and December 31, 2015. The latent class analysis included veterans’ diagnoses and acute care utilization.

Results: Medical, mental health, and substance use morbidity rates were high. More than half of the sample utilized Veterans Health Administration Homeless Programs concurrently with their super-utilization of acute care. There were 7 subgroups of super-utilizers, which varied considerably on the degree to which their super-utilization persisted over time. Approximately a third of the sample met super-utilizer criteria for ≥3 quarters; this group was older and disproportionately male, non-Hispanic white, and unmarried, with lower rates of post-9/11 service and higher rates of rural residence and service-connected disability. They were much more likely to be currently homeless with more medical, mental health, and substance use morbidity.

Conclusion: Only a subset of homeless veterans were persistent super-utilizers, suggesting the need for more targeted interventions.

*National Center for Homelessness Among Veterans, Philadelphia, PA

National Center for Homelessness Among Veterans, University of Alabama at Birmingham School of Public Health, Birmingham, AL

Providence VA Medical Center, Providence, RI

§VHA Support Service Center, Johnson City, TN

National Center for Homelessness among Veterans, Providence VA Medical Center, Providence, RI

This material is based upon work supported by the Department of Veterans Affairs, Veterans Health Administration, National Center on Homelessness among Veterans. The views expressed in this article are those of the authors and do not necessarily reflect the position or policy of the Department of Veterans Affairs or the United States government.

The authors declare no conflict of interest.

Reprints: Dorota Szymkowiak, PhD, National Center for Homelessness Among Veterans, 4100 Chester Avenue, Suite 201, Philadelphia, PA 19104. E-mail:

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