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

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Community emergency care use for low-acuity conditions is rising among Veterans, increasing non-VA spending. Younger, female, and more distant patients are more likely to use these services, suggesting a need for targeted interventions.

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Area of Science:

  • Health Services Research
  • Health Policy
  • Medical Informatics

Background:

  • Veterans Affairs (VA) legislation expanded community emergency care access.
  • Understanding low-acuity emergency department (ED) and urgent care (UC) utilization is vital for budgeting and care continuity.
  • Existing tools for identifying low-acuity ED visits have limitations.

Purpose of the Study:

  • To update and publicly release a diagnosis code list for identifying low-acuity ED visits.
  • To describe low-acuity community ED/UC visits and their users.
  • To assess patient characteristics associated with community facility use for low-acuity care.

Main Methods:

  • Retrospective cross-sectional study analyzing International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) codes (FY 2018-2023).
  • Calculated severity probabilities for 4694 codes, with 2439 (52.0%) identified as low acuity.
  • Used logistic regression to identify patient-level factors associated with community low-acuity care utilization.

Main Results:

  • Low-acuity diagnoses comprised 35.1% of community ED visits and 83.8% of community UC visits.
  • Visits for low-acuity conditions in community EDs and UCs increased over the study period.
  • Younger age, female sex, and greater distance from a VA ED were associated with higher odds of using community settings for low-acuity care.

Conclusions:

  • Community ED and UC use for low-acuity conditions is increasing, though still lower than VA rates, leading to higher non-VA spending.
  • Targeted interventions could redirect low-acuity community ED visits to more cost-effective settings.
  • The updated diagnosis code list can aid in better resource allocation and care management for Veterans.