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Factors Associated With Veterans Use of Community vs VA Emergency Departments
Anita A Vashi1,2,3, Steven M Asch1,4, Tracy Urech1
1Center for Innovation to Implementation, VA Palo Alto Health Care System, Menlo Park, California.
Importance:
The US Department of Veterans Affairs (VA) aims to ensure all veterans have access to emergency care, whether at VA or community facilities. However, the factors influencing where veterans seek care remain poorly understood.
Objective:
To assess factors associated with veterans use of community vs VA EDs.
Design, Setting, And Participants:
This retrospective cross-sectional study included all veterans aged 18 years or older with at least 1 VA or community ED visit across the contiguous US and Puerto Rico between October 1, 2021, and September 30, 2022. Data were analyzed from October 3, 2024, to March 10, 2025.
Exposures:
Patient demographics, clinical characteristics, prior VA and community health care use, differential distance to the nearest VA and community EDs, and facility complexity.
Main Outcomes And Measures:
Community or VA ED visit. Logistic regression models were used to assess factors associated with community ED use compared with VA ED use.
Results:
The sample included 2 777 564 ED visits by 1 359 850 veterans (mean [SD] age, 61.9 [16.1] years; 1 202 964 [88.5%] male). Of these visits, 1 000 437 (36.0%) occurred at community EDs. Community ED use was associated with greater differential ED distance (>64.0 km: adjusted odds ratio [AOR], 16.20; 95% CI, 15.96-16.44), prior community ED use (≥5 prior visits: AOR, 17.87; 95% CI, 17.14-18.63), and high-acuity diagnoses (eg, cardiac arrest and ventricular fibrillation: AOR, 84.57, 95% CI, 65.47-109.25). Prior VA ED visits (1 prior visit: AOR, 0.28; 95% CI, 0.28-0.28) and primary care use (AOR, 0.78; 95% CI, 0.77-0.79) were associated with lower odds of community ED use. Racial and ethnic minority veterans were consistently less likely to use community EDs compared with White veterans (Asian veterans: AOR, 0.64 [95% CI, 0.61-0.67]; Black veterans: AOR, 0.76 [95% CI, 0.76-0.77]; and Hispanic veterans: AOR, 0.73 [95% CI, 0.72-0.74]).
Conclusions And Relevance:
In this cross-sectional study, community ED use among veterans was associated with geographic access, prior care patterns, and diagnosis acuity. Targeted strategies appear to be needed to strengthen care coordination and ensure equitable emergency care access.
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