What Drives Frequent Emergency Department Use in an Integrated Health System? National Data From the Veterans Health Administration

The sociodemographic and clinical factors associated with frequent ED use within the Veterans Health Administration (VHA) are examined in this study.

Hospitals administrators and policy-makers are interested in the characteristics of those frequenting emergency departments (ED) for care.

This cross-sectional analysis uses fiscal year 2010 data from the national VHA database. All veterans who used VHA services in fiscal year 2010 were included. Patients were divided into six ED use frequency categories: 0, 1, 2 to 4, 5 to 10, 11 to 25, and greater than 25 ED visits per year. The Gelberg-Andersen Behavioral Model for Vulnerable Populations was used as a conceptual framework for identifying and classifying factors potentially associated with ED use.

Key Findings:

  • Of 5,531,379 patients receiving VHA services in fiscal year 2010, 83.2 percent had no VHA ED visit, 8.9 percent had 1 ED visit, 6.4 percent had 2 to 4 visits, 1.3 percent had 5 to 10 visits, and 0.2 percent had 11 to 25 visits, and 0.01 percent had greater than 25 visits.
  • Mean income decreased as ED use increased while mean age decreased as ED use increased.
  • Schizophrenia, homelessness, opioid prescription use, and heart failure were most strongly associated with ED use across multiple-use-frequency levels.

This study uses administrative data rather than self-reported data, providing an opportunity to understand use patterns within a health system Overall, this study shows that frequent VHA ED users are similar to other hospitals’ frequent ED user.