Rebecca Kartje, MD, MS; Brian E. Dixon, MPA, PhD; Ashley L. Schwartzkopf, MSW, LSW; Vivian Guerrero, MA; Kimberly M. Judon, MPH; Joanne C. Yi, RHIA; Kenneth Boockvar, MD, MS
Corresponding Author: Rebecca Kartje, MD, MS; U.S. Department of Veterans Affairs. Email: rebecca.kartje@va.gov
Section: Original Research
Publication: 3/26/2021
Introduction: Understanding how Veterans dually utilize VA for primary care and non-VA acute care can help policy makers predict future use of VA and non-VA healthcare resources. We aimed to describe characteristics of Veterans enrolled in a multisite clinical trial of non-VA acute event notifications and care coordination and to identify patient factors associated with non-VA acute care encounters. Methods: Characteristics of 565 Veterans enrolled in a prospective cluster randomized trial at the Bronx or Indianapolis VA Medical Centers between February 1, 2016 and February 1, 2019 were obtained by interview and chart review. Alerts of non-VA ED or inpatient admissions were based on standardized electronic messages exchanged between VA and non-VA facilities. Results: Veterans’ mean age was 75.8 years old, 98.3% were male, and 39.2% self-identified as a minority race; 81.2% reported receiving the majority of their care at the VA. There were 197 (34.9%) Veterans for whom a non-VA acute care alert was received during the study period. Patient characteristics significantly associated with a greater odds of a non-VA alert included: older age (OR = 1.05; 95% CI,1.04-1.05); endorsing that majority of care received is non-VA (OR = 1.83; 95% CI, 1.06-3.15); private insurance (OR = 1.39; 95% CI, 1.19-1.62); and higher income (OR = 4.01; 95% CI, 2.68-5.98). Conclusions: We identified several patient-level factors associated with non-VA acute care utilization which can inform the design of VA services and policies related to Veterans who experience non-VA acute care encounters and their reintegration back into the VA system.