Frequent emergency department (ED) visits often underline significant, unmet needs spanning medical, behavioral, and social dimensions. Recognizing these cascading patterns is essential to developing effective health interventions. This report highlights the crucial need for targeted ED strategies by unveiling the frequency and underlying causes of repeated ED visits among veterans.
Study Design and Methodology
Researchers conducted a comprehensive longitudinal cohort study of Veterans Health Administration enrollees, employing administrative data from 2018 to 2022 to analyze ED utilization. A particular focus was on both VA and non-VA settings to provide a broad perspective on frequent ED use. Veterans making four or more annual ED visits were classified as frequent users. This study evaluated which veterans continued frequent ED use over three and five years and identified predictors within this pattern, including five-year mortality rates and other correlating factors.
Significant Findings and Observations
Approximately 12-13% of VA enrollees qualified as frequent ED visitors annually. Among the 174,510 individuals identified as frequent users in 2018, only 14% maintained this level of high utilization after three years, reducing to 5% after five years. This indicates considerable turnover in frequent ED usage. Primary diagnoses among these users included chest pain, low back pain, urinary tract infections, suicide attempts, and chronic obstructive pulmonary disease. Notable persistence predictors comprised Black race and existing medical or mental health conditions. Significantly, while frequent use dropped among community users, their five-year mortality rate was almost double at 40%.
- The study shows a stark difference in mortality rates between persistent ED users in VA and community settings.
- Medical and mental health comorbidities play a vital role in persistent ED usage.
- Community user’s mortality rates suggest a critical need for interventions outside traditional VA settings.
Most veterans exhibit a reduction in high emergency department usage over time. However, those who continue such frequent visits face an alarming mortality risk. Recognizing persistence predictors and engaging in early risk stratification could enhance care management and offer necessary end-of-life planning. The integration of behavioral health strategies within the ED could foster more cohesive and effective healthcare solutions for these vulnerable groups. Addressing the disparities between VA and non-VA settings remains crucial in ensuring comprehensive care for high-risk populations.
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