An Examination of Frequent Emergency Department Use and Emergency Department Reliance among OIF/OEF Veterans

Frequent emergency department (ED) use has been studied for decades but frequent ED user subgroups have not been adequately studied, classified, and validated by the research community so designing clear, focused policies have remained problematic. This study used a cross-sectional design, using secondary data obtained from national Veteran Health Administration’s (VHA) administrative databases for fiscal years 2010- 2011 in order to inform and enhance the VHA’s understanding about frequent ED users among the Operation Iraqi Freedom (OIF) and Operation Enduring Freedom (OEF) veteran group through the classification of distinct subgroups within the frequent ED user group including examining factors that explain variation in ED utilization among OIF/OEF veterans, address whether using Department of Veterans Affairs (VA) secondary data sources can classify distinct subgroups within a frequent ED user population, and determine if prior fiscal year ED utilization and associated factors can be used to predict future ED utilization. Using counts of ED visits as the dependent variable, results indicated that 5.2% of all ED OEF/OIF veteran users could be considered frequent ED users which is in alignment with previous studies. The adapted model of Andersen’s Behavioral Model of Health Services Use was adept at selecting predisposing, enabling, and need variables for our predictive models with a Zero-inflated Negative Binomial (ZINB) regression model. Results showed that veterans over 30 years of age within the OEF/OIF cohort had significant decreased odds of having another ED visit compared to the younger under 30 group. Compared to Whites, Blacks or African Americans were the only race group found to be significantly more likely to have increased numbers of ED visits. However, the final ZINB predictive regression model was unable to accurately predict future year utilization using only one prior year’s utilization and associated factors. Three distinct subgroups within ED users were identified, classified and characterized in this study: The Low ED-use/Low EDR subgroup constituted the majority of the sample, Based on primary care use, this subgroup has a primary care physician but never use the ED except in rare circumstances when they find themselves in the ED due to a traumatic event such as a broken bone, car accident or other type of true emergency; The Low EDuse/High EDR subgroup, which consisted of veterans who based on primary care use also have a primary care physician who helps them manage a chronic illness such as Asthma or Diabetes but had an incident where their chronic illness gets out of control after business hours and requires a trip to the ED for care. The High ED-use/High EDR subgroup consisted of those veterans who based on primary care use may or may not have a primary care physician and appear to use the ED as a source of usual care or as a method to access the VA system in order to obtain pain medications, care for their physical needs, or counseling for mental health needs since all of these services are in high demand within the VA system and often difficult to gain access to these services in a timely manner