. Background. Emergency care is a critical, but understudied, part of the continuum of services offered to Veterans by the VA. While the VA is committed to providing timely and high-quality emergency care, surprisingly little is known about Veteran access to acute care or about the quality of care provided. Using a model derived from the development and widespread use of ambulatory care sensitive conditions (ACSCs) we propose using the emergency care sensitive condition (ECSC), a newly defined concept, as a novel framework to examine variation in access to and quality of emergency care systems. Analogous to ACSCs, ECSCs are conditions for which early access to high-quality emergency diagnosis and intervention in acute illness or acutely decompensated chronic illness improves patient outcomes. Objectives. This pilot lays the groundwork for two subsequent Investigator Initiated Research proposals that will examine access to emergency care and the individual, organizational and system factors related to ECSC outcomes, such as survival rates and 30 day post-discharge events. Our specific objectives for this pilot are. (1) to create a VA Emergency Department (ED) visit level dataset that can be used as part of a future study of Veteran utilization of emergency care across VHA and non-VHA settings; (2) to calculate the prevalence and determine variation, if any, of ECSCs across all VHA EDs; and (3) to refine the recently defined list of ECSCs and identify the ECSCs of most import to Veterans. Project Methods. First, using VA administrative files, we will construct a database that includes women and men Veterans aged 18 years and over who had any VA care, including outpatient, inpatient, non-VA care (Fee) services, or pharmacy services identified in the ADUSH Enrollment File FY10-FY12. All ED visits among the cohort will be identified. ED visits will be specified to be either an (1) ED visit resulting in discharge [ED tret-and-release visit], (2) ED visit resulting in hospital admission, (3) ED visit resulting in patient death, (4) an ED observation stay or (5) fee basis non-VA ED visit. The database will be structured to reflect the anticipated three-level analysis structure (i.e., visits are clustered by patients, which in turn, are clustered within stations). Next, using descriptive statistics, we wil calculate prevalence and determine variation, if any, of ECSCs across all VHA EDs. Finally, using a modified Delphi approach, we will refine the list of ECSCs of import to Veterans. These data will us to design and conduct a national study of the Veteran-, ED-, system-, and geographic-level predictors of access to high quality ED care.
This is an opportunity to critically examine and foster improvement of the organization of emergency care within the VA. Our pilot will apply the novel of approach of emergency care sensitive conditions (ECSCs), analogous to ambulatory care sensitive conditions, to the VA. ECSCs reflect antecedent poor access to and quality of emergency systems care. The pilot will set the stage for a national study of individual and system factors that might lead to acute care deficits, including geographic access and emergency department capabilities. Ultimately, our results will provide a knowledge-base from which important policy decisions can be made about how to best organize the emergency care system in its ability to serve Veterans on a daily basis and in times of crisis.
