title: Health services use of older veterans treated and released from veterans affairs medical center emergency departments.
abstract: OBJECTIVE
  To determine predictors of repeat health service use in older veterans treated and released from the emergency department (ED).
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  Veterans Affairs Medical Center (VAMC) EDs.
  
  
  METHODS
  Nationally representative sample of veterans aged 65 and older treated and released from one of 102 VAMC EDs between October 1, 2007, and June 30, 2008.
  
  
  METHODS
  Logistic regression models were used to examine the association between independent variables and primary outcomes (30-day repeat ED visits and hospital admissions).
  
  
  RESULTS
  In 31,206 older veterans, ED diagnoses were commonly related to chronic conditions (22.5%), injuries and acute musculoskeletal conditions (19%), and infections (13.5%). Within 30 days, 22% of older veterans had returned to the ED (n = 4,779) or been hospitalized (n = 2,005). In adjusted models, factors associated with greater odds of repeat ED visits than injury were homelessness (odds ratio (OR) = 1.6, 95% confidence interval (CI) = 1.3-2.1), previous ED visits (OR = 1.7, 95% CI = 1.6-1.8), previous hospitalization (OR = 1.3, 95% CI = 1.2-1.4), and index ED visit related to infection (1.2, 95% CI = 1.1-1.3). Odds of subsequent hospital admission were higher in veterans with previous hospitalization (OR = 2.5, 95% CI = 2.2-2.8), who were homeless (OR = 1.5, 95% CI = 1.1-2.0), who had aid and attendance benefits (OR = 1.5, 95% CI = 1.2-1.8), who were unmarried (OR = 1.2, 95% CI = 1.1-1.3), and who had an ED visit related to a chronic condition (OR = 1.4, 95% CI = 1.2-1.6) than in those with injury.
  
  
  CONCLUSIONS
  A substantial proportion of older veterans treated and released from a VAMC ED returned to the ED or were hospitalized within 30 days. Intervening with high-risk older veterans after an ED visit may reduce unscheduled healthcare use.
authors.affiliation: Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, North Carolina; Geriatrics Research, Education and Clinical Center, Veterans Affairs Medical Center, Durham, North Carolina; Division of Geriatrics, Department of Medicine, Duke University, Durham, North Carolina; Center for the Study of Aging and Human Development, Duke University, Durham, North Carolina.
authors.forename: Susan Nicole
authors.initials: SN
authors.lastname: Hastings
authors.forename: Valerie A
authors.initials: VA
authors.lastname: Smith
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Eugene Z
authors.initials: EZ
authors.lastname: Oddone
authors.forename: Maren K
authors.initials: MK
authors.lastname: Olsen
authors.forename: Kenneth E
authors.initials: KE
authors.lastname: Schmader
mesh_terms: D004636:Emergency Service, Hospital; D005500:Follow-Up Studies; D006299:Health Services for the Aged; D006787:Hospitals, Veterans / Q000458:organization & administration*; D006801:Humans; D010351:Patient Discharge; D012189:Retrospective Studies; D014481:United States; D014728:Veterans
keywords: emergency department; health services use among aged; multimorbidity