Assessing methods to identify Veterans Health Administration populations with Veterans Justice Programs contact to improve health research.

Abstract

Military veterans with criminal legal involvement have a need for healthcare and housing to attenuate their risks of suicide, overdose, and homelessness. Links between criminal legal involvement and Veterans Health Administration (VHA) care are poorly understood, partly because it is challenging to correctly identify veterans with criminal legal involvement. This study's primary objective was to assess VHA data sources and codes from the electronic health record that indicate contact with Veterans Justice Programs (VJP) staff - a broad proxy for criminal legal involvement. We examined three data sources used in previous research to identify veterans who had contact with VJP staff: (1) presence of VJP clinic stop codes in the outpatient encounter records, (2) Homeless Outreach Management and Evaluation System (HOMES) VJP form records collected during VJP outreach, and (3) chart note titles that included VJP terms. In Fiscal Year 2024, there were 52,672 unique VHA-eligible veterans with VJP contact as determined by at least one indicator: 80% with clinic stop codes, 22% with HOMES records, and 63% with chart note titles (Fleiss' κ = 0.22, p < .001). Patient characteristics varied in their association with each data source, suggesting substantial proportions of veterans with specific characteristics who received VJP services would be missing when only one or two data sources were used. Depending on the data source, diagnosis of a clinical condition varied by 9% and there was a 6% difference observed in a performance measure. These results suggest that the use of all three data sources to identify veterans with VJP contact is the most comprehensive strategy among those examined. Results are most applicable to VHA, the largest healthcare system to serve a criminal legal involved population, and provide information that other healthcare systems may need various data sources and indicators to identify patients with criminal legal involvement.