Refining a diagnostic code list to investigate low-acuity utilization by veterans

Recent Veterans Affairs (VA) legislation expanding access to community (non-VA) emergency care use has important implications for budget and policy. Understanding drivers of community emergency department (ED) and urgent care (UC) utilization for low-acuity conditions is crucial for budgeting and improving care continuity, but current tools for identifying low-acuity ED visits have significant limitations. This study aimed to update and make publicly available a dichotomous diagnosis code list to identify low-acuity ED visits. We describe low-acuity community ED/UC visits and their users and assess patient-level characteristics associated with the use of community facilities.

Retrospective cross-sectional study.

We evaluated all International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) diagnoses with at least 100 ED visits across fiscal years 2018-2023. Severity probabilities were calculated and reviewed by 3 study personnel. Summary statistics were used to describe low-acuity community ED/UC visits. A logistic regression model was fitted to determine patient-level factors associated with using community settings for low-acuity care.

For code list refinement, 4694 ICD-10 codes were reviewed, with 2439 (52.0%) rated as low acuity. Visits to community EDs and UCs for low-acuity conditions rose over the study period. Low-acuity diagnoses constituted 35.1% of community ED visits and 83.8% of community UC visits. Being younger, being female, and living farther from a VA ED were associated with greater odds of using community settings for low-acuity care.

Community ED and UC utilization for low-acuity conditions remains below rates in VA settings but is rising, resulting in increased non-VA spending. Targeted interventions may be useful in redirecting low-acuity community ED use to lower-cost settings.