Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

VA Health Systems Research

Go to the VA ORD website
Go to the QUERI website

SDR 21-232 – HSR Study

SDR 21-232
Evaluating the Impact of COVID-19 on Case Management, Health Care Utilization, and Housing Outcomes for HUD-VASH Veterans
Eric Jutkowitz, PhD
Providence VA Medical Center, Providence, RI
Providence, RI
Funding Period: June 2023 - May 2025


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.

External Links for this Project

NIH Reporter

Grant Number: I01HX003562-01A2

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project


None at this time.

DRA: Mental, Cognitive and Behavioral Disorders, Health Systems, Other Conditions
DRE: TRL - Applied/Translational
Keywords: Homeless, Outcomes - Patient
MeSH Terms: None at this time.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.