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Area of Science:

  • Health Services Research
  • Public Health
  • Healthcare Informatics

Background:

  • Low-acuity conditions constitute a significant portion of emergency department (ED) visits within the Veterans Affairs (VA) Health System.
  • The COVID-19 pandemic accelerated the adoption of virtual care within the VA, but its effect on low-acuity ED utilization was unclear.

Purpose of the Study:

  • To analyze trends in low-acuity VA ED visits before and after the implementation of expanded virtual care.
  • To determine if changes in the use of alternative care settings were associated with ED utilization patterns.

Main Methods:

  • A retrospective, cross-sectional study utilizing interrupted time series analysis.
  • Evaluation of monthly low-acuity ED visit data from March 2017 to February 2023, using VA Corporate Data Warehouse and Integrated Veteran Care administrative claims.
  • Inclusion of secondary analyses on patient characteristics and associations between ED and alternative care use.

Main Results:

  • A total of 10,364,893 VA ED visits by 2,592,998 veterans were analyzed.
  • Low-acuity ED visits initially dropped by 24,514 in March 2020, followed by a monthly increase from May 2020 but remained below baseline.
  • No direct association was found between virtual care utilization and reduced ED visits for low-acuity conditions.

Conclusions:

  • Low-acuity ED utilization decreased after the expansion of VA virtual care, but direct substitution was not evident.
  • Findings suggest a shift in care-seeking behaviors within the VA system.
  • Further investigation into quality, access, and system-level outcomes related to these changing care patterns is warranted.