2.3. VA administrative data

Demographic and clinical characteristics extracted from VA's longstanding EHR included age, gender, race and ethnicity, VA priority status, rurality, housing instability, and comorbid conditions. We included patient race and ethnicity as recorded in the VA EHR on the study data pull date at the medical center where the patient had their most recent outpatient visit analyzed as (1) Black, (2) Hispanic, (3) Other race, including American Indian or Alaska Native, Asian, Native Hawaiian or Other Pacific Islander, and those who reported more than one race (4) White and (5) missing, which includes those with no recorded race or ethnicity, those who declined to answer, and those who responded unknown. Housing instability was defined using VA Managerial Cost Accounting Stop Codes reflecting the use of homeless services and diagnosis code Z59.0 and ascertained in the year prior to the survey. ¹⁸ , ¹⁹ Geocoded enrollment data provided information on rurality based on Rural–Urban Community Areas. ²⁰ The VA priority‐based enrollment system categorizes patients (hierarchically) into eight groups based on their service‐connected disability rating, income, recent military service, and other factors. ²¹ We defined veterans with high disability as those in priority groups 1 and 4; low/moderate disability include groups 2, 3, and 6; low‐income group 5; no service‐connected disability groups 7 and 8.

Chronic physical and mental health conditions were identified based on at least one outpatient encounter with an ICD‐10 code for the condition in the year before the survey. We included 47 chronic conditions derived from the Agency for Health care Research and Quality Clinical Classifications Software and VA's Women's Health Evaluation Initiative. ²² , ²³ , ²⁴ A score for alcohol use, based on the 3‐item measure (Alcohol Use Disorders Identification Test–Consumption [AUDIT‐C]), was also extracted from the EHR.

VA EHR encounters, Fee Basis, and Program Integrity Tool claims were used to identify VA‐provided, VA‐purchased Community Care ED visits. Medicare Outpatient or Inpatient Revenue Center claims were used to identify ED visits outside VA.