PROJECT SUMMARY The federal eviction moratorium and local eviction moratoria that were implemented during the COVID-19 pandemic presents a unique opportunity to study the impact of eviction-related policies on healthcare use and costs. The long-term goal is to bridge the knowledge and investments of the housing and healthcare fields to address evictions as a social determinant of health that affects disparities in health and healthcare services. The central hypothesis is that eviction moratoria policies can reduce use of homeless and acute care services and tenant-landlord relationships are important to sustain housing stability. The rationale for this project is to guide future development of policies and practices related to evictions with data from the healthcare sector to prevent homelessness and acute care use. Guided by preliminary work, this project has three specific aims: 1) Assess the impact of the federal eviction moratorium and local eviction moratoria on rates of eviction and use of homeless programs; 2) Evaluate the impact of eviction moratoria on use of acute healthcare services and cost; and 3) Examine relationships between tenants and landlords in urban and rural areas during the federal eviction moratorium. To achieve these three aims, data on over 10 million patients from 2018-2023 served by the U.S. Department of Veterans Affairs (VA) healthcare system- the largest integrated system in the U.S. with a comprehensive electronic medical record system- will be analyzed. For the first aim, an innovative natural language processing system will be deployed to identify eviction cases in the medical record and to test hypotheses that the federal and local eviction moratoria reduced rates of evictions and use of homeless programs. For the second aim, impact analyses will be conducted to test the central hypothesis that the federal and local eviction moratoria reduced use of acute care services and costs. Within the context of these first two aims, sociodemographic and clinical characteristics predictive of eviction risk, homeless program use, and acute care use will be identified to inform targeted prevention initiatives. For the third aim, qualitative interviews will be conducted with 50 dyads of tenants and their landlords in Texas and New York about their experiences with the federal eviction moratorium and the role of tenant-landlord relationships in the eviction process, which will shed light on ways that tenants and landlords can be incentivized and considered important partners in eviction prevention and policies. The research proposed in this application is innovative because it uses new data science methods applied to the largest U.S. healthcare system to understand a unique set of policies around evictions, all of which can contribute to needed knowledge in this area. The proposed research is significant because it will help address evictions as an important public health problem associated with housing and health disparities with implications for the healthcare field. Ultimately, the project has the potential to advance the fields of housing and healthcare to better serve diverse and vulnerable populations.

PROJECT NARRATIVE The proposed research will use a national medical record system of over 10 million patients to evaluate the impact of U.S. eviction moratoria policies on use and costs of homeless and acute healthcare services in communities across the country. The project will deploy an innovative method to identify evictions in medical records that can be used for future evaluations and utilize qualitative interviews with dyads of tenants and landlords in urban and rural regions to understand their experiences during eviction moratoria. Together, this work will inform future policies and practices related to evictions, homelessness, and acute care use with the goal of addressing social and health inequities in vulnerable populations.