After-hours, Severity, and Distance Are Associated with Non-VHA Emergency Department Use for Older Veterans: Insights from a Regional Health Information Exchange

Authors

Elina Kurkurina, Quinnipiac UniversityFollow
Kimberly M. Judon, James J. Peters VA Medical CenterFollow
Ula Hwang, NYU Langone HealthFollow
Kenneth S. Boockvar, University of Alabama at BirminghamFollow
Juan Wisnivesky, Icahn School of Medicine at Mount SinaiFollow
Matthew R. Augustine, James J. Peters VA Medical CenterFollow

Author ORCID Identifier

0000-0002-1025-2741

Abstract

Background: Older adults treated in emergency departments (EDs) are at higher risk for adverse outcomes. Using multiple facilities can worsen this issue through service duplication and poor care transitions. Veterans with dual insurance coverage can access both Veterans Health Administration (VHA) and non-VHA EDs. This study aimed to identify factors associated with non-VHA ED use among veterans.

Methods: We conducted a retrospective observational study of patients aged ≥ 65 who had primary care at the James J Peters VA Medical Center and at least one VHA or non-VHA ED visit between October 2017 and February 2020. Data were collected from the Veterans Affairs Corporate Data Warehouse and the Bronx Regional Health Information Exchange Organization. Generalized linear mixed models were used to examine factors influencing non-VHA ED use.

Results: The study sample consisted of 3,897 veterans and a total of 13,312 ED visits. Compared to VHA-exclusive ED users, non-VHA ED users were more likely to live farther away (OR 1.04, CI 1.02 – 1.06) and seek care outside regular hours, including mornings (OR 1.61, CI 1.39 – 1.87), nights (OR 1.49, CI 1.33 – 1.66), weekends (OR 1.28, CI 1.16 – 1.42), and holidays (OR 1.32, CI 1.04 – 1.68). They were also more likely to present with emergency care sensitive conditions (OR 2.13, CI 1.90 – 2.37) and recent inpatient hospitalizations (OR 1.22, CI 1.05 – 1.41).

Conclusion: These findings suggested that distance and acuity are important predictors of non-VHA ED use in urban areas such as the Bronx, NY. Identifying veterans with key risk factors could improve care coordination and potentially reduce non-VHA ED use.

Creative Commons License

This work is licensed under a Creative Commons Attribution-NonCommercial-No Derivative Works 4.0 International License.

Recommended Citation

Kurkurina, Elina; Judon, Kimberly M.; Hwang, Ula; Boockvar, Kenneth S.; Wisnivesky, Juan; and Augustine, Matthew R. (2024) "After-hours, Severity, and Distance Are Associated with Non-VHA Emergency Department Use for Older Veterans: Insights from a Regional Health Information Exchange," Journal of Geriatric Emergency Medicine: Vol. 5: Iss. 4, Article 9.
DOI: https://doi.org/10.17294/2694-4715.1100
Available at: https://institutionalrepository.aah.org/jgem/vol5/iss4/9