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

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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. J Am Geriatr Soc 61:1515–1521, 2013.

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