My name is Adi Gundlapalli,
I’m an infectious disease physician
and informatics specialist.
I’m at the Salt Lake City VA,
and I’m the Chief Health Informatics Officer
for the VA Salt Lake City Healthcare System,
and a staff physician there.
Our veterans face many challenges
as they transition from military service to civilian life,
and several of those challenges include economic instability,
social support or lack thereof, mental health disorders,
alcohol and substance abuse,
and so our goal has been to try and improve our understanding
of that subset of veterans who face housing challenges.
The way we’re approaching it is to look at structured data,
which consists of administrative data,
such as ICD-9 codes,
visits to different VA healthcare centers
and also looking at unstructured data,
which is free text medical notes.
We’re looking at the free text medical notes,
and teaching the computer to look for clues or evidence
for early homelessness in those notes.
The goal there is try and see if we can mitigate and prevent
and intervene before they become homeless.
The time of separation
form the military active duty service members
are given a separation category.
So, unfortunately there is a category called misconduct
for which our service members
have gotten into some sort of challenges during service.
Only less than 6 percent of them are discharged or separated
from the military for misconduct.
However, whenever when we looked at homelessness rates
in those veterans at 30 days,
and one year and then five years after separation,
or coming to the VA,
we found that nearly one quarter of all homeless veterans
were from the misconduct category.
That to date is probably one of the most significant
predictors of homelessness.
The idea there would be while they transition,
then maybe the VA and the Department of Defense,
we can use existing programs.
The VA has tremendous amount of existing programs
for case management and for helping veterans
who are facing housing challenges
so if we do more of a warm handoff
and an active case management
of this subset of the vulnerable,
then maybe we can mitigate and intervene on their behalf.
As a staff physician,
I have the honor and privilege of treating veterans
when they are in the hospital,
and as we’re doing our rounds and looking at them,
it’s always in the back of my mind,
in terms of their risk for homelessness,
and the challenges they’re facing.
And so we try to bring that perspective and say,
“Oh if you’re going to send this patient home
"with this medication or this particular treatment option
"or home health, well, do they have a home?
"Do they have social support?
"Can someone change their bandages?
Can they help them with the IV antibiotics?”
So I think it does help bring that perspective
down to the individual veteran level.
And similarly, when we’re talking to others on rounds
or hearing from our house staff or students or colleagues,
and see, “Oh this challenge we’re facing
and we don’t understand why this is going on,”
it’s nice to bring that back to the researcher’s table
and say, “There’s a high priority question,”
and maybe we can offer them some answers
or at least do hypothesis-generating
so we can look at how to improve the care
and quality of life for our veterans.
If we’re able to look at and help even individual veterans,
I think it’s very humbling
to see the challenges they’ve gone through,
and thank them for their service.
In VA hospitals, we see all periods of service represented:
the elderly, the WW1, and subsequently
Vietnam era veterans, and nowadays we’re seeing
both in the outpatient and inpatient clinic
the younger OEF/OIF,
and Operation New Dawn veterans also coming in.
So I think it does make a difference.
We have to know every day
when we walk into the medical center and the clinic
why we’re here and work toward that common goal
of improving the healthcare
and the quality of life for our veterans.