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Emergency Department Utilization by Veterans for Low-Acuity Conditions After Virtual Care Expansion
Anu Ramachandran1,2, Linda Diem Tran3,4, Steven Asch1,5
1Center for Innovation to Implementation, Veterans Affairs (VA) Palo Alto Health Care System, Menlo Park, California.
Importance:
Low-acuity conditions account for 60% of emergency department (ED) visits within the Veterans Affairs Health System (VA). The COVID-19 pandemic led to rapid expansion of VA virtual care, but the impact on low-acuity ED utilization remains unknown.
Objective:
To examine patterns in low-acuity VA ED visits before and after the expansion of virtual care and to assess whether changes in alternative care use were associated with ED utilization.
Design, Setting, And Participants:
This retrospective cross-sectional study used an interrupted time series analysis to evaluate monthly patterns in low-acuity ED visits from March 1, 2017, through February 28, 2023, using VA Corporate Data Warehouse encounter data supplemented with administrative claims from the Office of Integrated Veteran Care. Participants included veterans presenting for acute unscheduled care at EDs within the VA. Secondary analyses included patient characteristics of low-acuity ED users and associations between ED and alternative care utilization. Data were analyzed from March 1, 2024, to August 30, 2025.
Exposures:
System-wide expansion of VA virtual care from March 15 to May 30, 2020.
Main Outcomes And Measures:
The primary outcome consisted of monthly counts of low-acuity visits to VA EDs.
Results:
The sample included 10 364 893 VA ED visits made by 2 592 998 veterans (mean [SD] age, 60.8 [16.1] years; 9 284 407 [89.6%] by male patients). Low-acuity ED utilization dropped by 24 514 (95% CI, 12 351-36 677) visits (P < .001) in March 2020. From May 2020 onward, low-acuity visits increased by a mean of 7863 (95% CI, 93-15 633) per month (P = .047) but remained 12.4% below baseline by the end of the study period. High-acuity ED visits showed similar patterns. No association was observed between virtual care utilization and reductions in ED use for selected low-acuity conditions.
Conclusions And Relevance:
In this cross-sectional, national study of ED visits within the VA, low-acuity utilization declined following the expansion of virtual care; however, evidence of direct substitution was not detected. These findings highlight shifting care patterns within the VA and underscore the need for further research on quality, access, and system-level outcomes.
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