Predictors of County-Level Home Modification Use Across the US

Area of Science:

• Public Health
• Health Services Research
• Geospatial Analysis

Background:

• Geospatial analyses reveal non-uniform prescription and utilization of the Home Improvements and Structural Alterations (HISA) program for home modification (HM) services within the US Department of Veterans Affairs (VA).
• This uneven distribution suggests underlying factors influencing access and uptake of essential services for veterans.

Purpose of the Study:

• To identify county-level characteristics associated with varying rates of HISA utilization.
• To explore the influence of clinical care, quality of care, physical environment, and sociodemographic factors on HISA program usage.

Main Methods:

• Utilized multiple regression analysis to predict county-level HISA utilization rates.
• Examined county-level variables including clinical care, quality of care, physical environment, and sociodemographic data.

Main Results:

• HISA use varied significantly across US counties, with a mean utilization rate of 6.6%.
• The percentage of uninsured adults in a county was negatively associated with HISA utilization (b = -8.99, P = .005).
• The rate of preventable hospital stays was positively associated with HISA utilization (b = .0004, P = .009), while housing quality was not a significant predictor.

Conclusions:

• This study quantifies and predicts HISA utilization at the county level, addressing a gap in understanding geographic variations.
• Findings highlight the impact of sociodemographic factors (uninsured rate) and healthcare system indicators (preventable hospital stays) on HISA access.
• Further research is needed to fully understand and mitigate geographical disparities in HISA use, aiming to improve access to home modifications for veterans with disabilities.