# Social and Behavioral Determinants of Health in High-Risk Veterans

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2021 · —

## Abstract

Background. Social factors exert a substantially more potent impact on health than does health care, especially
among disadvantaged populations such as VA users. Adverse social determinants of health (SDH)—factors such
as housing instability, food insecurity, social isolation, and transportation barriers—are linked to problems with
access, poorer clinical outcomes, and increased health care costs. Despite the clinical and business case for
integrating SDHs into health care, these factors are not systematically assessed or addressed in clinical settings.
Significance/Impact. This study will leverage a previous survey of Veterans at high-risk for hospitalization, and a
new survey to be fielded to a nationally-representative sample of Veterans, to determine how SDHs influence
clinical, health care utilization, and experience outcomes. Review of findings by key stakeholders will generate
recommended SDH measures for universal screening within VA. These steps, coupled with qualitative interviews
about implementation challenges, will inform the future integration of high-value patient-reported SDH measures
into VA’s health record.
Innovation. The proposed work is innovative in its evaluation of a broad array of SDHs in high-need Veterans
to identify candidate measures for electronic health record (EHR) integration. The study will leverage a
theoretically-driven survey of SDH measures with a data-driven approach to identifying the associations between
these SDHs and a range of health, utilization, and patient experience outcomes. Results from these analyses
will inform a facilitated deliberative process to prioritize high-value, validated, and actionable measures that are
predictive of outcomes that are important to Veterans and the VA.
Specific Aims. In Aim 1, we will use data from an Office of Primary Care-funded survey of Veterans at high-risk
for hospitalization to examine relationships between patient-reported SDH measures and utilization, cost, and days
in the community outcomes. In Aim 2, we will field a survey to a nationally-representative sample of VA patients to
determine the association between SDH measures and key outcomes, and to examine the prevalence of SDHs in
subpopulations of Veterans who are disproportionately affected by disparities (e.g., women, racial/ethnic minorities,
and rural Veterans). Aims 1 and 2 will inform partner and stakeholder discussions in Aim 3 to identify measures
that are associated with key outcomes and that are perceived by operations partners as actionable (i.e.,
addressable through VA or community services) and thereby good candidates for EHR integration.
Methodology. In Aim 1, we will leverage data from an operations-funded survey that our team administered in
2018. Using survey data for 4,685 Veterans at high-risk for hospitalization, we will examine the association
between patient-reported SDHs and utilization (i.e., VA and Medicare emergency department visits and
hospitalizations), VA and Medicare costs, a...

## Key facts

- **NIH application ID:** 10313362
- **Project number:** 1I01HX003269-01A2
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** MATTHEW L MACIEJEWSKI
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2021
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2021-10-01 → 2025-09-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10313362

## Citation

> US National Institutes of Health, RePORTER application 10313362, Social and Behavioral Determinants of Health in High-Risk Veterans (1I01HX003269-01A2). Retrieved via AI Analytics 2026-05-24 from https://api.ai-analytics.org/grant/nih/10313362. Licensed CC0.

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