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Member Research & Reports

Member Research & Reports

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

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.

A team of investigators, including Dr. Ann Elizabeth Montgomery, from University of Alabama at Birmingham School of Public Health, engaged in a study to explore 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.

They conducted a qualitative study using in-depth semi-structured interviewing. Interviews were conducted with VHA physician and non-physician practitioners who had administered the HSCR and documented at least five positive screens between 2013 and 2015. Transcripts were analyzed using a modified grounded theory approach.

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.

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