Abstract
The National Call Center for Homeless Veterans (NCCHV) is available 24 hours/7 days a week to connect Veterans experiencing homelessness or risk with information, referrals, and linkages to Veterans Affairs (VA) and community-based services. This study describes characteristics of call center contacts (n = 251 668) with Veterans during 2019-2023, including demographics, identified social needs, and contact outcomes. The majority of contacts were made by Veterans themselves (vs third party) and most frequently resulted in NCCHV referring the Veteran to their local VA Medical Center; most Veterans who contacted NCCHV had previously used VA healthcare. This study offers insights into which Veterans may need additional attention to connect to VA care and those who remain at high risk of housing instability after connecting with VA. Future work should assess how Veterans are linked with care, with the goal of improving the response to Veterans’ needs and guide strategies to prevent homelessness.
Keywords: call center, housing instability, Veteran
The US Department of Veterans Affairs (VA) National Call Center for Homeless Veterans (NCCHV) provides information, referrals, and linkages to services for Veterans experiencing homelessness or risk, 24 hours/7 days a week, with the objective of connecting Veterans to VA and community-based services.1 NCCHV is an integral yet understudied component of VA’s comprehensive program to address housing instability.2
There have been few studies of call centers focused on homelessness, with a paucity of data focused on who contacts them and their outcomes. At least one study of a call center that offered homelessness prevention assistance in Chicago found the assistance can greatly reduce homelessness.3 A preliminary analysis found that during the period November 30, 2018, to October 31, 2020, 266 100 contacts were made to NCCHV representing 110 197 unique Veterans, 20% of whom reported experiencing homelessness and 69% of whom reported being at risk.4
The present study describes characteristics and needs of Veterans accessing NCCHV over a 5-year period using administrative data, with the objective of understanding which Veterans are contacting NCCHV, whether they were already connected to VHA care, and what is needed to prevent and end homelessness among all Veterans who contact NCCHV. This extends prior work by using more recent data and a longer observation period.
Methods
Data sources
NCCHV data included information about all contacts (ie, Veterans and individuals who contacted NCCHV on their behalf) including name, date of birth, Social Security Number, and phone numbers. We matched NCCHV data with the Master Veteran Index (MVI), VA’s authoritative source for personal identity data, using an iterative deterministic matching algorithm adapted from the SEER-Medicare linkage algorithm. We utilized the VA’s universal health identifier to link MVI Veteran records to US Veterans Eligibility Trends and Statistics (USVETS) data and records in the Veterans Health Administration (VHA) Corporate Data Warehouse (CDW), which includes Veterans’ socio-demographics, health and social services use, and medical diagnoses. USVETS data include socioeconomic, demographic, and military service data.
Cohort and assessments
During the period from January 1, 2019, to December 31, 2023, NCCHV received 802 868 contacts via phone or chats: 509 197 (64.4%) were made by or on behalf of an identifiable Veteran and 219 029 (27.3%) were made by or on behalf of a Veteran who remained anonymous; the remaining 74 642 (9.3%) contacts were by non-Veterans. We identified 278 785 unique Veterans who contacted NCCHV directly or for whom someone contacted NCCHV on their behalf after removing contacts by Veterans who remained anonymous or were unidentified and non-Veterans as well as deduplicating Veteran contacts (n = 1873) and excluding Veterans who were deceased prior to a contact made on their behalf (n = 1468). Approximately 98.5% of unique Veterans completed an assessment during their initial contact with the NCCHV. Their data comprise the findings in this paper.
Among 278,785 unique Veterans, we linked 251,668 with VHA data: 76.2% (n = 191 687) engaged with VHA services at some point during the 2 years prior to their first contact with NCCHV (ie, VHA Users) while the remaining 23.8% (n = 59,981) did not (ie, VHA Non-Users). Among VHA Users, 188,149 completed an initial assessment as did 59,234 VHA Non-Users. For the purposes of the present study, we rely on contacts’ initial assessments. For 66% of Veterans, this was their only assessment, although 34% of unique Veterans contacted NCCHV on a subsequent occasion. See Supplemental Digital Content Figure S1, available at http://links.lww.com/JPHMP/B582.
Measures
The measures reported in the present paper reflect NCCHV data, supplemented by MVI, USVETS, and CDW data. Veteran characteristics include age; sex; race; ethnicity; region from which the contact was made; military characteristics including branch, rank, and discharge status; income; family obligations; and legal issues. Housing status represents the combination of two variables: (1) whether the Veteran reported current homelessness or imminent risk of homelessness and (2) Veterans’ self-reported current living situation (eg, unsheltered, sheltered, permanent housing). The data also include length of time homeless for those who self-reported experiencing current homelessness. Contact characteristics include the identity of the person making the contact (ie, Veteran themselves, Veteran’s family member, Veteran’s care provider), whether there was a subsequent contact with NCCHV, and the year and season when the contact took place. Outcome of contact includes (1) whether a Veteran was referred to an urban or rural facility for follow-up; (2) the action taken by NCCHV, including referral to a local VA Medical Center (VAMC), counseling offered during contact, or no action (ie, contact disconnected, Veteran refusal); and (3) the action taken by the local VAMC where the Veteran was referred, including loss to follow-up (ie, no referral or contact with Veteran, Veteran ineligible, Veteran refused), referral to specific VHA Homeless Programs (ie, Health Care for Homeless Veterans, US Departments of Housing and Urban Development-VA Supportive Housing, and Grant and Per Diem), referral to community-based assistance, if the Veteran was hospitalized, or other/missing outcomes.
Analysis
We summarized all variables of interest and conducted bivariate analysis using chi-square and Wilcoxon signed rank tests to compare characteristics from assessments completed during initial contact for Identifiable Veterans stratified by Veteran status (ie, Unconfirmed Veterans, Veterans Unknown to VA, VHA Non-Users, VHA Users). We also conducted supplementary analyses comparing characteristics of all completed NCCHV assessments stratified by contact source (ie, contacts from Identifiable Veteran, contacts from Anonymous Veterans, contacts from Non-Veterans; Supplemental Digital Content Table S1, available at http://links.lww.com/JPHMP/B582) and characteristics of assessments completed during initial contact for VHA Veterans stratified by (a) race, (b) sex, and (c) age (Supplemental Digital Content Tables S2-S4, available at http://links.lww.com/JPHMP/B582).
The study protocol was reviewed and approved by the VA Central Institutional Review Board (IRB) and was granted a waiver of informed consent.
Results
Table 1 displays the comparison of Veterans’ responses to their first assessment conducted by NCCHV, stratified by VHA use status. Not unexpectedly, less information was available for Unconfirmed Veterans and Veterans Unknown to VA, comprising about 10% of the sample of Veteran contacts. Of note, Unconfirmed Veterans less frequently contacted NCCHV themselves and most frequently received counsel, answer, or transfer by NCCHV. Unconfirmed and Veterans Unknown to VA also less frequently made contact with their local VAMC.
TABLE 1.
First NCCHV Assessment for Unique Veterans
| Unique Veterans, N (%) |
Unconfirmed Veterans, N (%) |
Veterans Unknown to VA, N (%) |
VHA Non-Users, N (%) |
VHA Users, N (%) |
Test of Group Difference P-value |
|
|---|---|---|---|---|---|---|
| N— Veterans | 278 785 (100) | 13 830 (5.0) | 13 287 (4.8) | 59 981 (21.5) | 191 687 (68.8) | |
| N— Assessments | 273 465 (100) | 12 993 (4.8) | 13 089 (4.8) | 188 149 (68.8) | 59 234 (21.7) | |
| Veteran characteristics | ||||||
| Age, years | <.001 | |||||
| <35 | 62 017 (22.7) | 1270 (9.8) | 4539 (34.7) | 18 615 (31.4) | 37 593 (20.0) | |
| 35-49 | 67 551 (24.7) | 1446 (11.1) | 2846 (21.7) | 15 287 (25.8) | 47 972 (25.5) | |
| 50-64 | 82 128 (30.0) | 2128 (16.4) | 3614 (27.6) | 16 585 (28.0) | 59 801 (31.8) | |
| 65+ | 56 086 (20.5) | 2596 (20.0) | 1984 (15.2) | 8733 (14.7) | 42 773 (22.7) | |
| Missing | 5683 (2.1) | 5553 (42.7) | 106 (0.8) | 14 (0.0) | 10 (0.0) | |
| Sex | <.001 | |||||
| Male | 218 164 (79.8) | 1971 (15.2) | 9973 (76.2) | 49 027 (82.8) | 157 193 (83.6) | |
| Female | 43 891 (16.1) | 54 (0.4) | 2678 (20.5) | 10 204 (17.2) | 30 955 (16.5) | |
| Missing | 11 407 (4.2) | 10 968 (84.4) | 435 (3.3) | 3 (0.0) | 1 (0.0) | |
| Race | <.001 | |||||
| White | 128 241 (46.9) | 30 081 (50.8) | 98 160 (52.2) | |||
| Black | 104 756 (38.3) | 24 275 (41.0) | 80 481 (42.8) | |||
| Pacific Islander | 2689 (1.0) | 584 (1.0) | 2105 (1.1) | |||
| Native American | 4697 (1.7) | 1304 (2.2) | 3393 (1.8) | |||
| Asian | 3022 (1.1) | 806 (1.4) | 2216 (1.2) | |||
| Missing/Declined | 30 060 (11.0) | 12 993 (100.0) | 13 089 (100.0) | 2184 (3.7) | 1794 (1.0) | |
| Ethnicity | <.001 | |||||
| Hispanic | 21 913 (8.0) | 5548 (9.4) | 16 365 (8.7) | |||
| Non-Hispanic | 222 500 (81.4) | 51 646 (87.2) | 170 854 (90.8) | |||
| Missing | 29 052 (10.6) | 12 993 (100.0) | 13 089 (100.0) | 2040 (3.4) | 930 (0.5) | |
| Region | <.001 | |||||
| South | 132 004 (48.3) | 5447 (41.9) | 5950 (45.5) | 28 064 (47.4) | 92 543 (49.2) | |
| West | 66 647 (24.4) | 3187 (24.5) | 2845 (21.7) | 15 167 (25.6) | 45 448 (24.2) | |
| Midwest | 36 064 (13.2) | 1520 (11.7) | 2048 (15.7) | 7639 (12.9) | 24 857 (13.2) | |
| Northeast | 27 932 (10.2) | 1363 (10.5) | 1671 (12.8) | 6682 (11.3) | 18 216 (9.7) | |
| US Territory | 453 (0.2) | 25 (0.2) | 11 (0.1) | 46 (0.1) | 371 (0.2) | |
| Missing | 10 365 (3.8) | 1451 (11.2) | 564 (4.3) | 1636 (2.8) | 6714 (3.6) | |
| Military branch | <.001 | |||||
| Army | 123 264 (45.1) | 27 408 (46.3) | 95 856 (51.0) | |||
| Navy | 46 453 (17.0) | 11 047 (18.7) | 35 406 (18.8) | |||
| Air Force | 25 820 (9.4) | 5896 (10.0) | 19 924 (10.6) | |||
| Marines | 28 173 (10.3) | 6523 (11.0) | 21 650 (11.5) | |||
| Coast Guard | 2037 (0.7) | 489 (0.8) | 1548 (0.8) | |||
| Unknown | 47 718 (17.5) | 12 993 (100.0) | 13 089 (100.0) | 7871 (13.3) | 13 765 (7.3) | |
| Military rank | <.001 | |||||
| Enlisted | 210 027 (76.8) | 48 503 (81.9) | 161 524 (85.9) | |||
| Commissioned Officer | 1779 (0.7) | 378 (0.6) | 1401 (0.7) | |||
| Warrant Officer | 153 (0.1) | 35 (0.1) | 118 (0.1) | |||
| Unknown/Missing | 61 506 (22.5) | 12 993 (100.0) | 13 089 (100.0) | 10 318 (17.4) | 25 106 (13.3) | |
| OTH discharge | 12 240 (4.5) | 5218 (8.8) | 7022 (3.7) | <.001 | ||
| Sources of income | ||||||
| Employment | 60 889 (22.3) | 1494 (11.5) | 4245 (32.4) | 17 140 (28.9) | 38 010 (20.2) | <.001 |
| Social Security | 47 304 (17.3) | 2594 (20.0) | 1615 (12.3) | 7459 (12.6) | 35 636 (18.9) | <.001 |
| SSI | 27 007 (9.9) | 1273 (9.8) | 1262 (9.6) | 5325 (9.0) | 19 147 (10.2) | <.001 |
| VA disability | 103 581 (37.9) | 1943 (15.0) | 537 (4.1) | 9711 (16.4) | 91 390 (48.6) | <.001 |
| VA pension | 8735 (3.2) | 451 (3.5) | 161 (1.2) | 981 (1.7) | 7142 (3.8) | <.001 |
| Family | 4532 (1.7) | 180 (1.4) | 273 (2.1) | 1082 (1.8) | 2997 (1.6) | <.001 |
| Other | 31 238 (11.4) | 1572 (12.1) | 1997 (15.3) | 7872 (13.3) | 19 797 (10.5) | <.001 |
| Income sufficient for housing | 57 647 (21.1) | 1667 (12.8) | 2290 (17.5) | 10 028 (16.9) | 43 662 (23.2) | <.001 |
| Family obligations | ||||||
| Spouse | 47 184 (17.3) | 1598 (12.3) | 2377 (18.2) | 10 774 (18.2) | 32 435 (17.2) | <.001 |
| Children | 71 373 (26.1) | 2015 (15.5) | 3629 (27.7) | 17 424 (29.4) | 48 305 (25.7) | <.001 |
| Parents | 2707 (1.0) | 83 (0.6) | 143 (1.1) | 552 (0.9) | 1929 (1.0) | 0.014 |
| Others | 34 543 (12.6) | 1090 (8.4) | 1736 (13.3) | 7685 (13.0) | 24 032 (12.8) | <.001 |
| Legal issues | 56 469 (20.7) | 1594 (12.3) | 2772 (21.2) | 12 946 (21.9) | 39 157 (20.8) | <.001 |
| Housing status | <.001 | |||||
| Homeless–unsheltered | 43 536 (15.9) | 2511 (19.3) | 2391 (18.3) | 10 739 (18.1) | 27 895 (14.8) | |
| Homeless–sheltered | 5770 (2.1) | 424 (3.3) | 347 (2.7) | 1389 (2.3) | 3610 (1.9) | |
| Homeless–unclassified | 3000 (1.1) | 283 (2.2) | 144 (1.1) | 673 (1.1) | 1900 (1.0) | |
| At risk–institutional | 11 104 (4.1) | 696 (5.4) | 468 (3.6) | 2152 (3.6) | 7788 (4.1) | |
| At risk–temporary housing | 82 553 (30.2) | 3246 (25.0) | 3944 (30.1) | 19 467 (32.9) | 55 896 (29.7) | |
| At risk–permanent housing | 100 548 (36.8) | 3503 (27.0) | 4484 (34.3) | 20 218 (34.1) | 72 343 (38.5) | |
| At risk–unclassified | 2764 (1.0) | 222 (1.7) | 146 (1.1) | 593 (1.0) | 1803 (1.0) | |
| Not homeless/not at risk | 14 895 (5.5) | 1331 (10.2) | 690 (5.3) | 2357 (4.0) | 10 517 (5.6) | |
| Not homeless/risk missing | 9295 (3.4) | 777 (6.0) | 475 (3.6) | 1646 (2.8) | 6397 (3.4) | |
| If homeless, length of time | <.001 | |||||
| More than a year | 7694 (14.7) | 603 (18.7) | 491 (17.0) | 2096 (16.4) | 4504 (13.5) | |
| 3-12 months | 8384 (16.0) | 498 (15.5) | 527 (18.3) | 2192 (17.1) | 5167 (15.5) | |
| Less than 3 months | 33 587 (64.2) | 1847 (57.4) | 1740 (60.4) | 7977 (62.3) | 22 023 (65.9) | |
| Missing | 2641 (5.1) | 270 (8.4) | 124 (4.3) | 536 (4.2) | 1711 (5.1) | |
| Contact characteristics | ||||||
| Identity of contact | <.001 | |||||
| Veteran | 213 677 (78.1) | 6618 (50.9) | 9745 (74.5) | 47 196 (79.7) | 150 118 (79.8) | |
| Family member | 19 718 (7.2) | 3163 (24.3) | 1336 (10.2) | 3833 (6.5) | 11 386 (6.1) | |
| Provider | 30 913 (11.3) | 2050 (15.8) | 1415 (10.8) | 6085 (10.3) | 21 363 (11.4) | |
| Friend | 4815 (1.8) | 631 (4.9) | 291 (2.2) | 1099 (1.9) | 2794 (1.5) | |
| Other | 4342 (1.6) | 531 (4.1) | 302 (2.3) | 1021 (1.7) | 2488 (1.3) | |
| Subsequent contact | 93 633 (34.2) | 1198 (9.3) | 3712 (28.4) | 21 664 (36.5) | 68 257 (36.1) | <.001 |
| Year of contact | ||||||
| 2019 | 52 436 (19.2) | 2621 (20.2) | 1765 (13.5) | 9522 (16.1) | 38 528 (20.5) | <.001 |
| 2020 | 46 060 (16.8) | 2776 (21.4) | 1699 (13.0) | 8964 (15.1) | 32 621 (17.3) | <.001 |
| 2021 | 51 350 (18.8) | 2583 (19.9) | 2057 (15.7) | 10 951 (18.5) | 35 759 (19.0) | <.001 |
| 2022 | 62 546 (22.9) | 2570 (19.8) | 3249 (24.8) | 14 797 (25.0) | 41 930 (22.3) | <.001 |
| 2023 | 61 073 (22.3) | 2443 (18.8) | 4319 (33.0) | 15 000 (25.3) | 39 311 (20.9) | <.001 |
| Season of contact | ||||||
| Spring | 64 069 (23.4) | 3238 (24.9) | 2887 (22.1) | 13 486 (22.8) | 44 458 (23.6) | <.001 |
| Summer | 72 201 (26.4) | 3238 (24.9) | 2887 (22.1) | 16 002 (27.0) | 50 074 (26.6) | <.001 |
| Fall | 71 210 (26.0) | 3392 (26.1) | 3530 (27.0) | 15 611 (26.4) | 48 677 (25.9) | <.001 |
| Winter | 65 804 (24.1) | 3169 (24.4) | 3560 (27.2) | 14 135 (23.9) | 44 940 (23.9) | <.001 |
| Outcome of contact | ||||||
| Referral facility | <.001 | |||||
| Urban | 253 036 (92.5) | 11 129 (85.7) | 12 057 (92.1) | 55 538 (93.8) | 174 312 (92.7) | |
| Rural | 10 055 (3.7) | 412 (3.2) | 468 (3.6) | 2058 (3.5) | 7117 (3.8) | |
| Missing | 10 374 (3.8) | 1452 (11.2) | 564 (4.3) | 1638 (2.8) | 6720 (3.6) | |
| NCCHV outcome | <.001 | |||||
| Referral: local VAMC | 250 965 (91.8) | 10 553 (81.2) | 12 029 (91.9) | 55 622 (93.9) | 172 761 (91.8) | |
| Counsel, answer, transfer | 19 139 (7.0) | 1560 (12.0) | 951 (7.3) | 3163 (5.3) | 13 465 (7.2) | |
| Disconnected | 1050 (0.4) | 263 (2.0) | 34 (0.3) | 139 (0.2) | 614 (0.3) | |
| Veteran refusal/no action | 2311 (0.9) | 617 (4.8) | 75 (0.6) | 310 (0.5) | 1309 (0.7) | |
| Local VAMC outcome | <.001 | |||||
| No local VAMC referral | 22 500 (8.2) | 2440 (18.8) | 1060 (8.1) | 3612 (6.1) | 15 388 (8.2) | |
| No contact with Veteran | 41 611 (15.2) | 2630 (20.2) | 2634 (20.1) | 10 535 (17.8) | 25 812 (13.7) | |
| Veteran not enrolled/eligible | 8215 (3.0) | 983 (7.6) | 1057 (8.1) | 2564 (4.3) | 3611 (1.9) | |
| Veteran refused service | 7151 (2.6) | 285 (2.2) | 268 (2.1) | 1117 (1.9) | 5481 (2.9) | |
| Referral: HCHV | 45 886 (16.8) | 1307 (10.1) | 1404 (10.7) | 9671 (16.3) | 33 504 (17.8) | |
| Referral: HUD-VASH/GPD | 23 863 (8.7) | 538 (4.1) | 490 (3.7) | 4546 (7.7) | 18 289 (9.7) | |
| Referral: Other VA program | 16 039 (5.9) | 546 (4.2) | 775 (5.9) | 3692 (6.2) | 11 026 (5.9) | |
| Referral: community program | 63 780 (23.3) | 2185 (16.8) | 2920 (22.3) | 13 238 (22.4) | 45 437 (24.2) | |
| Veteran hospitalized | 1254 (0.5) | 58 (0.5) | 31 (0.2) | 155 (0.3) | 1010 (0.5) | |
| Other/missinga | 42 866 (15.7) | 2021 (15.7) | 2450 (18.7) | 10 104 (17.1) | 28 591 (15.2) |
Abbreviations: GPD, Grant and Per Diem; HCHV, Health Care for Homeless Veterans; HUD-VASH, US Departments of Housing and Urban Development-VA Supportive Housing; NCCHV, National Call Center for Homeless Veterans; OTH, other than honorable; SSI, Supplemental Security Income; VA, Veterans Affairs; VAMC, VA Medical Center.
Local VAMC Outcome: Other/Missing = Outcome missing, other, off-site evaluation.
Among the Veterans who had linked VHA data, 76.1% were VHA Users and the remaining 23.9% were VHA Non-Users at the time of initial contact with NCCHV. VHA Non-Users were younger than VHA Users (31.4% vs 20.0% were <35 years), but there were no substantive differences in other demographic factors. VHA Non-Users were more than twice as likely to have an other than honorable discharge from the military (8.8% vs 3.7%). They were more likely to be employed and less likely to be in receipt of VA disability or pension benefits, compared with VHA Users. VHA Non-Users had a higher rate of homelessness and were homeless for a longer period of time compared with VHA Users. VHA Non-Users were slightly more likely than VHA Users to be referred to their local VAMC (93.9% vs 91.8%), but had less interaction with their local VAMC once referred (ie, no contact, not eligible for services). Supplemental Digital Content Tables S2-S4, available at http://links.lww.com/JPHMP/B582 present these data stratified by age, race, and sex, respectively.
Discussion
The majority of the 800 000 contacts received by NCCHV during 2019-2023 were made by Veterans themselves and nearly all were referred to their local VAMC to coordinate care. Most Veterans who contacted NCCHV were VHA VHA Users; however, about one-quarter of Veteran contacts had not received VHA services in the preceding 2 years before NCCHV contact. This finding illustrates that NCCHV serves a prevention, or early intervention, function for Veterans who are disengaged from VHA care and may advance a goal of VA’s long-range plan to be a primary choice for care.5
VHA Users were often older, reported being at risk of homelessness rather than currently homeless, and were less likely to have financial obligations to children compared with non-VHA users. We believe this finding yields policy insight. First, we infer that VA engagement may confer a level of protection against homelessness. The same pattern, however, also points to a population of non-VHA users who will need additional attention to avert homelessness. NCCHV can connect Veterans to wide-ranging resources to address homelessness risk including community-based services provided through programs such as Supportive Services for Veteran Families,6 which offers homelessness prevention, as well as VHA-based services offered through the Health Care for Homeless Veterans program and others.7 A preliminary study of NCCHV found that Veterans who had a VA record and contacted NCCHV had large increases in use of VHA Homeless Programs after contact with NCCHV (increase of 55%) as well as small, significant increases in use of medical and psychiatric services after NCCHV contact.4 Additional research is required to describe the services obtained, whether they enhance housing outcomes, and to identify Veterans at the greatest risk of housing instability, for whom further engagement with VHA matters most.
A limitation of this study is that some NCCHV records did not include sufficient information to determine engagement with VA care; however, this study offers insights into which Veterans may need additional attention to connect to VHA care and those who remain at high risk of housing instability.
Supplementary Material
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Web site (http://www.JPHMP.com).
Implications for Policy & Practice.
NCCHV serves a prevention, or early intervention, function for Veterans who are disengaged from VHA care.
First, we infer that VA engagement may confer a level of protection against homelessness. The same pattern, however, also points to a population, non-VHA users, who will need additional attention to avert homelessness.
While NCCHV is an important resource for Veterans experiencing housing instability in rural areas, more research is needed to understand whether there are rural/urban differences in Veterans’ access to care following a contact with NCCHV.
Additional work must assess how Veteran contacts are linked with care and how well those linkages work, with the goal of improving the response to Veterans’ needs and guide strategies to prevent homelessness.
Acknowledgments
This study was funded by the US Department of Veterans Affairs, Health Systems Research (IIR-22-048, PIs: A.E.M. & J.T.). The views and opinions presented herein are those of the author and do not necessarily represent the views of the federal government.
Footnotes
The authors declare no conflicts of interest.
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