Health Services Use of Older Veterans Treated and Released from Veterans Affairs Medical Center Emergency Departments

Authors

  • Susan Nicole Hastings MD, MHSc,

    Corresponding author
    1. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
    2. Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
    3. Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina
    4. Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
    • Address correspondence to S. Nicole Hastings, Veterans Affairs Medical Center, Durham, NC 27705. E-mail: susan.hastings@dm.duke.edu

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  • Valerie A. Smith MS,

    1. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
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  • Morris Weinberger PhD,

    1. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
    2. Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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  • Eugene Z. Oddone MD, MHSc,

    1. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
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  • Maren K. Olsen PhD,

    1. Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina
    2. Department of Biostatistics and Bioinformatics, Duke University, Durham, Carolina
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  • Kenneth E. Schmader MD

    1. Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina
    2. Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina
    3. Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina
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Abstract

Objectives

To determine predictors of repeat health service use in older veterans treated and released from the emergency department (ED).

Design

Retrospective cohort study.

Setting

Veterans Affairs Medical Center (VAMC) EDs.

Participants

Nationally representative sample of veterans aged 65 and older treated and released from one of 102 VAMC EDs between October 1, 2007, and June 30, 2008.

Measurements

Logistic regression models were used to examine the association between independent variables and primary outcomes (30-day repeat ED visits and hospital admissions).

Results

In 31,206 older veterans, ED diagnoses were commonly related to chronic conditions (22.5%), injuries and acute musculoskeletal conditions (19%), and infections (13.5%). Within 30 days, 22% of older veterans had returned to the ED (n = 4,779) or been hospitalized (n = 2,005). In adjusted models, factors associated with greater odds of repeat ED visits than injury were homelessness (odds ratio (OR) = 1.6, 95% confidence interval (CI)  = 1.3–2.1), previous ED visits (OR = 1.7, 95% CI = 1.6–1.8), previous hospitalization (OR = 1.3, 95% CI = 1.2–1.4), and index ED visit related to infection (1.2, 95% CI = 1.1–1.3). Odds of subsequent hospital admission were higher in veterans with previous hospitalization (OR = 2.5, 95% CI = 2.2–2.8), who were homeless (OR = 1.5, 95% CI = 1.1–2.0), who had aid and attendance benefits (OR = 1.5, 95% CI = 1.2–1.8), who were unmarried (OR = 1.2, 95% CI = 1.1–1.3), and who had an ED visit related to a chronic condition (OR = 1.4, 95% CI = 1.2–1.6) than in those with injury.

Conclusion

A substantial proportion of older veterans treated and released from a VAMC ED returned to the ED or were hospitalized within 30 days. Intervening with high-risk older veterans after an ED visit may reduce unscheduled healthcare use.

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