Center for Innovation to Implementation, Veterans Affairs Palo Alto Health Care System, Menlo Park, California.
Department of Emergency Medicine, University of California, San Francisco.
JAMA Netw Open. 2024 Mar 4;7(3):e241626. doi: 10.1001/jamanetworkopen.2024.1626.
Recently passed legislation aimed at improving access to care has considerably expanded options for veterans to receive emergency care in community, or non-Veterans Affairs (VA) settings. However, national trends in community emergency department (ED) use by veterans are unknown.
To examine national, temporal trends in the frequencies and types of ED visits provided in community settings and explore the association between facilities' purchase of community care with facility and regional characteristics.
DESIGN, SETTING, AND PARTICIPANTS: Retrospective, observational cross-sectional study of ED visits over fiscal years (FY) 2016 to 2022. VA and community ED encounter data were obtained from the VA Corporate Data Warehouse and the Office of Integrated Veteran Care. Participants were veterans receiving ED care at VA facilities or paid for by the VA in the community. Data were analyzed from June to September 2023.
The primary outcome measures included community ED visit volume, disposition, and payments over time. Also, the most common and costly ED visits were assessed. Negative binomial regression analysis examined associations between facility and regional characteristics and the rate of ED visits purchased in community settings relative to all ED visits.
There were 19 787 056 ED visits, predominantly at VA facilities (14 532 261 visits [73.4%]), made by 3 972 503 unique veterans from FY 2016 to 2022. The majority of ED users were male (3 576 120 individuals [90.0%]), and the median (IQR) age was 63 (48-73) years. The proportion of community ED visits increased in absolute terms from 18% in FY 2016 to 37% in FY 2022. Total community ED payments, adjusted to 2021 dollars, were $1.18 billion in FY 2016 and over $6.14 billion in FY 2022. The most common reasons for ED visits in the community were for nonspecific chest pain (305 082 visits [6%]), abdominal pain (174 836 visits [3%]), and septicemia (149 968 visits [3%]). The average proportion of ED visits purchased by a VA facility increased from 14% in FY 2016 to 32% by FY 2022. In multivariable analyses, facilities with greater ED volume and low-complexity facilities had higher expected rates of community emergency care than lower volume and high-complexity facilities, respectively.
As veterans increasingly use community EDs for acute, unscheduled needs, attention to factors associated with veterans' use of acute care services in different settings are important to identify access barriers and to ensure veterans' health care needs are met.
最近通过的旨在改善医疗服务可及性的立法，极大地扩大了退伍军人在社区（或非退伍军人事务部（VA））环境中获得紧急护理的选择。然而，退伍军人在社区急诊部（ED）使用方面的全国趋势尚不清楚。
研究社区 ED 就诊的全国性、时间趋势，以及探讨设施购买社区护理与设施和地区特征之间的关联。
设计、地点和参与者：回顾性、观察性的横截面研究，研究时间为 2016 财年至 2022 财年。VA 和社区 ED 就诊数据来自 VA 公司数据仓库和综合退伍军人护理办公室。参与者为在 VA 设施接受 ED 护理或由 VA 在社区支付费用的退伍军人。数据分析于 2023 年 6 月至 9 月进行。
主要结局指标包括随时间推移的社区 ED 就诊量、处置和支付情况。还评估了最常见和最昂贵的 ED 就诊。负二项式回归分析考察了设施和地区特征与相对于所有 ED 就诊，社区 ED 就诊购买率之间的关联。
2016 财年至 2022 财年期间，共有 19787056 人次 ED 就诊，主要在 VA 设施（14532261 人次[73.4%]），由 3972503 名独特的退伍军人就诊。大多数 ED 用户为男性（3576120 人[90.0%]），中位（IQR）年龄为 63（48-73）岁。绝对而言，社区 ED 就诊的比例从 2016 财年的 18%增加到 2022 财年的 37%。以 2021 年美元计算，社区 ED 支付总额从 2016 财年的 11.8 亿美元增加到 2022 财年的 61.4 多亿美元。社区就诊最常见的原因是不明原因胸痛（305082 人次[6%]）、腹痛（174836 人次[3%]）和败血症（149968 人次[3%]）。VA 设施购买 ED 就诊的平均比例从 2016 财年的 14%增加到 2022 财年的 32%。在多变量分析中，ED 量较大和低复杂度的设施比 ED 量较小和高复杂度的设施更有可能购买更多的社区急诊服务。
随着退伍军人越来越多地将社区 ED 用于急性、非计划性需求，关注与退伍军人在不同环境中使用急性护理服务相关的因素对于识别获取障碍和确保退伍军人的医疗保健需求得到满足很重要。
