Persistent Emergency Department Use Among Veterans: Longitudinal Patterns and Opportunities for Targeted Intervention

Area of Science:

• Health Services Research
• Epidemiology
• Health Outcomes

Background:

• Persistent frequent emergency department (ED) use can indicate unmet medical, behavioral, and social needs.
• Understanding patterns and predictors of frequent ED use is vital for developing targeted interventions and care coordination strategies.
• Frequent ED utilization is a significant concern within the Veterans Health Administration (VA) system.

Purpose of the Study:

• To examine patterns of frequent ED use among VA enrollees.
• To identify predictors of persistent frequent ED utilization.
• To assess outcomes, including mortality, for frequent ED users, with a focus on community ED users.

Main Methods:

• A national longitudinal cohort study using VA administrative data from 2018 to 2022.
• Defined frequent ED use as ≥4 visits annually.
• Assessed persistence over 3 and 5 years, evaluated predictors (sociodemographic, clinical, system-level), and calculated 5-year mortality rates.

Main Results:

• Annually, 12-13% of VA enrollees were frequent ED users.
• Among those with frequent ED use in 2018, 14% persisted at 3 years and 5% at 5 years.
• Predictors of persistence included Black race, comorbidities, and higher baseline ED use; 5-year mortality was 24% for frequent ED users and nearly 40% for frequent community ED users.

Conclusions:

• Most frequent ED users do not sustain high utilization, but persistent users experience high mortality.
• Early identification and risk stratification are essential for effective ED-based care management.
• Integration of behavioral health and end-of-life planning are critical for vulnerable frequent ED users.