Insights for conducting large-scale surveys with veterans who have experienced homelessness

ABSTRACT

Surveys of underserved patient populations are needed to guide quality improvement efforts but are challenging to implement. The goal of this study was to describe recruitment and response to a national survey of Veterans with homeless experience (VHE). We randomly selected 14,340 potential participants from 26 U. S. Department of Veterans Affairs (VA) facilities. A survey contract organization verified/updated addresses from VA administrative data with a commercial address database, then attempted to recruit VHE through 4 mailings, telephone follow-up, and a $10 incentive. We used mixed-effects logistic regressions to test for differences in survey response by patient characteristics. The response rate was 40.2% (n = 5766). Addresses from VA data elicited a higher response rate than addresses from commercial sources (46.9% vs 31.2%, p < .001). Residential addresses elicited a higher response rate than business addresses (43.8% vs 26.2%, p < .001). Compared to non-respondents, respondents were older, less likely to have mental health, drug, or alcohol conditions, and had fewer VA housing and emergency service visits. Collectively, our results indicated a national mailed survey approach is feasible and successful for reaching VA patients who have recently experienced homelessness. These findings offer insight into how health systems can obtain perspectives of socially disadvantaged groups.

Abbreviations: H-PACTS: Homeless-Patient Aligned Care Teams; SHEP: Survey of Healthcare Experiences of Patients; SRG: Strategic Research Group; USPS: United States Postal Service; VA: U.S. Department of Veterans Affairs; VHE: veterans with homeless experience

KEYWORDS:

• Homeless persons
• survey research design and methods
• veterans
• administrative data uses
• patient assessment and satisfaction

Acknowledgments

Dr. Jones acknowledges support from the National Center for Advancing Translational Sciences of the National Institutes of Health under Award Number UL1TR002538 and KL2TR002539, and an HSR&D Career Development Award (CDA 19-233, Award No IK2HX003090-01A2).

Disclosure statement

No potential conflict of interest was reported by the author(s).

Additional information

Funding

This work was supported by the U.S. Department of Veterans Affairs, Health Services Research and Development (IIR 15-095).

Notes on contributors

Aerin J. deRussy

Aerin J. deRussy, MPH is a public health researcher focused on homeless-experienced Veterans, suicide prevention, and health care quality.

Audrey L. Jones

Audrey L. Jones, PhD is a health services scholar focused on improving mental health and substance abuse services access, quality, and outcomes for vulnerable Veteran populations.

Erika L. Austin

Erika L. Austin, PhD, MPH is a social scientist whose research focuses on the health of marginalized populations.

Adam J. Gordon

Adam J. Gordon, MD, MPH is an internal medicine doctor and scholar of evaluating systems of care that improve medical care for patients with addiction or experiences of homelessness.

Lillian Gelberg

Lillian Gelberg, MD is a family physician and pioneering investigator in health services research for vulnerable populations.

Sonya E. Gabrielian

Sonya E. Gabrielian, MD, MPH is a psychiatrist and health services researcher focusing on improving improve housing, health, and community functioning for homeless-experienced adults with serious mental illness.

Kevin R. Riggs

Kevin R. Riggs, MD, MPH is an internal medicine doctor and health services researcher focused on improving care for substance use disorders.

John R. Blosnich

John R. Blosnich, PhD, MPH is a research health scientist focused on mental health and health disparities among vulnerable Veteran populations with an emphasis on social determinants of health.

Ann Elizabeth Montgomery

Ann Elizabeth Montgomery, PhD is a scholar in health behavior and homelessness who led the development of a homeless screener for the Veterans Health Administration.

Sally K. Holmes

Sally K. Holmes, MBA is a scholar of organizational research and evaluation with a focus on system redesign or process improvement in health care organizations.

Allyson L. Varley

Allyson L. Varley, PhD is an implementation scientist who utilizes mixed-methods approaches to explore patient-centered service design for Veterans with homeless experiences and Veterans with chronic pain.

April E. Hoge

April E. Hoge, MPH is a public health researcher focused on homeless-experienced adults and health care quality.

Stefan G. Kertesz

Stefan G. Kertesz, MD is a primary care doctor and health services researcher focused on improving access to quality medical care for homeless and underserved populations.