Neighborhood characteristics are associated with residents' healthcare use. However, we understand less about these relationships among formerly homeless persons, who often have complex healthcare needs, including mental health and substance use disorders. Among formerly homeless Veterans, we examined: (a) how neighborhood characteristics are associated with Veteran Health Administration (VHA) healthcare use and, (b) if these relationships varied by Veterans' level of healthcare need. We obtained data on our cohort of 711 Veterans housed through VHA's permanent supportive housing program (HUD-VASH) in 2016-2017 from VHA's Homeless Registry, VHA's electronic health records, and the U.S. Census. We studied the relationships between neighborhood characteristics (% Veteran, % in poverty, % unemployed, % using public transportation, and % vacant properties) and VA healthcare use (primary care visits, outpatient mental health visits, and "high use" of emergency departments [> 4 visits]) using mixed-effects logistic and negative binomial regression models, controlling for patient demographics. We further examined moderation by patient healthcare need (calculated from cost and clinical data). We found that veterans in neighborhoods with higher percentages of residents who (a) were Veterans or (b) used public transportation were more likely to have high emergency department use. Those in neighborhoods with higher public transportation use had more primary care visits while those in neighborhoods with more property vacancies had more outpatient mental health visits. Among those with high healthcare needs, residents of areas with more Veterans had higher emergency department use. Promoting public transportation use and social engagement with other Veterans in residential neighborhoods may influence HUD-VASH Veterans' VA healthcare use. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

中文翻译：

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永久支持性住房中前无家可归退伍军人的医疗服务利用：社区重要吗？

社区特征与居民的医疗保健使用相关。然而，我们对以前无家可归者之间的这些关系知之甚少，他们往往有复杂的医疗保健需求，包括心理健康和药物滥用障碍。在以前无家可归的退伍军人中，我们研究了：(a) 社区特征如何与退伍军人健康管理局 (VHA) 医疗保健使用相关，以及 (b) 这些关系是否因退伍军人的医疗保健需求水平而变化。我们从 VHA 无家可归者登记处、VHA 电子健康记录和美国人口普查中获取了 2016-2017 年通过 VHA 永久支持性住房计划 (HUD-VASH) 安置的 711 名退伍军人的数据。我们研究了社区特征（退伍军人百分比、贫困百分比、失业百分比、使用公共交通百分比和空置房产百分比）和 VA 医疗保健使用（初级保健就诊、门诊心理健康就诊和急诊科“高使用率”）之间的关系[> 4 次就诊]）使用混合效应逻辑回归模型和负二项式回归模型，控制患者人口统计数据。我们进一步研究了患者医疗保健需求的调节（根据成本和临床数据计算）。我们发现，在 (a) 退伍军人或 (b) 使用公共交通的居民比例较高的社区中，退伍军人更有可能使用急诊室。公共交通使用率较高的社区的居民接受初级保健的次数较多，而房产空置较多的社区的居民接受心理健康门诊的次数较多。在医疗保健需求较高的人群中，退伍军人较多地区的居民对急诊科的使用率较高。促进公共交通的使用以及与住宅区其他退伍军人的社交参与可能会影响 HUD-VASH 退伍军人的 VA 医疗保健使用。（PsycInfo 数据库记录 (c) 2022 APA，保留所有权利）。