VA records were examined for all individuals listed on an official roster indicating they had served in the U.S. military as part of the recent conflicts in Iraq or Afghanistan. Specifically, these include those who were deployed as part of Operation Enduring Freedom (OEF), Operation Iraqi Freedom (OIF), and Operation New Dawn (OND). This roster consisted of 941,970 Veterans who separated from the military after deployment as part of OEF/OIF/OND and who were eligible for and enrolled in VA health care services as of July 2011. Of these, 845,593 (89.8%) had at least one documented encounter within the VA system as of April 2012. Records from this latter group were taken from a nationwide VA research database of administrative and clinical data managed by Veterans Informatics and Computing Infrastructure (VINCI) [12 ] to ascertain homelessness.
Veterans were selected for analysis if they belonged to one of three mutually exclusive homeless groups, based on the first administrative record with any of the following homelessness-related indicators: 1) V60.0, 2) V60.x, and 3) non-ICD indicators of homelessness. The first category included all those with records of receiving a V60.0 ICD-9-CM code as part of a VA contact. The second category included those who received any of three V60.x series ICD-9-CM codes related to housing circumstances: V60.1 (inadequate housing), V60.89 (other specified housing or economic circumstances) and V60.9 (unspecified housing or economic circumstances) (see Table 1). The final category included those whose records contained at least one of a set of specific non-ICD VA clinic codes or treatment specialty codes[7 ]. These include VA-specific codes that designate the clinic where the Veteran received a particular homeless service:

522 (Department of Housing and Urban Development VA Shared Housing [HUD-VASH]);

528 (Telephone/Homeless Mentally Ill [HMI]);

529 (Healthcare for Homeless Veterans);

530 (Telephone/HUD-VASH); and

590 (Community outreach to homeless Veterans by staff)

as well as the inpatient treatment specialty codes (homeless services for hospitalized Veterans):

37 Domiciliary care for homeless Veterans (DCHV); and

28 Mental Health Residential and Rehab Treatment Program for Compensated Work Therapy/Treatment Resident (MH RRTP CWT/TR).

Only Veterans who had at least one additional VA visit in the 90 days immediately following the identification of homelessness were retained in the sample to allow for an examination of receipt of at least one service (and associated ICD-9-CM codes) after the initial homeless designation. Outpatient clinic visits in the 90 days immediately after the first indicator of homelessness were categorized as either homeless, mental health, or substance abuse/addiction services. Additionally, comorbidities among VA homeless groups were also explored by summarizing their ICD-9-CM diagnoses. VA medical center region and station identification was also obtained from the administrative data.
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