What type of study is this?

This is a Cross-Sectional Study study.

December 8, 2025JAMA Network Open1 citationsOpen Access

Factors Associated With Veterans Use of Community vs VA Emergency Departments

TUTracy UrechVA Palo Alto Health Care System SWSiqi WuHebei Agricultural University

Key Points

Community ED use correlates with increased distance and prior visits, suggesting access plays a key role.
Racial minority veterans are less likely to choose community EDs compared to White veterans, highlighting disparities.
Logistic regression revealed that higher acuity diagnoses significantly influence the choice of ED.
Targeted strategies are needed to enhance equitable access to emergency care for veterans.

Abstract

Importance The US Department of Veterans Affairs (VA) aims to ensure all veterans have access to emergency care, whether at VA or community facilities. However, the factors influencing where veterans seek care remain poorly understood. Objective To assess factors associated with veterans use of community vs VA EDs. Design, Setting, and Participants This retrospective cross-sectional study included all veterans aged 18 years or older with at least 1 VA or community ED visit across the contiguous US and Puerto Rico between October 1, 2021, and September 30, 2022. Data were analyzed from October 3, 2024, to March 10, 2025. Exposures Patient demographics, clinical characteristics, prior VA and community health care use, differential distance to the nearest VA and community EDs, and facility complexity. Main Outcomes and Measures Community or VA ED visit. Logistic regression models were used to assess factors associated with community ED use compared with VA ED use. Results The sample included 2 777 564 ED visits by 1 359 850 veterans (mean SD age, 61.9 16.1 years; 1 202 964 88.5% male). Of these visits, 1 000 437 (36.0%) occurred at community EDs. Community ED use was associated with greater differential ED distance (gt;64.0 km: adjusted odds ratio AOR, 16.20; 95% CI, 15.96-16.44), prior community ED use (≥5 prior visits: AOR, 17.87; 95% CI, 17.14-18.63), and high-acuity diagnoses (eg, cardiac arrest and ventricular fibrillation: AOR, 84.57, 95% CI, 65.47-109.25). Prior VA ED visits (1 prior visit: AOR, 0.28; 95% CI, 0.28-0.28) and primary care use (AOR, 0.78; 95% CI, 0.77-0.79) were associated with lower odds of community ED use. Racial and ethnic minority veterans were consistently less likely to use community EDs compared with White veterans (Asian veterans: AOR, 0.64 95% CI, 0.61-0.67; Black veterans: AOR, 0.76 95% CI, 0.76-0.77; and Hispanic veterans: AOR, 0.73 95% CI, 0.72-0.74). Conclusions and Relevance In this cross-sectional study, community ED use among veterans was associated with geographic access, prior care patterns, and diagnosis acuity. Targeted strategies appear to be needed to strengthen care coordination and ensure equitable emergency care access.

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