• S Nicole Hastings, Valerie A Smith, Morris Weinberger, Kenneth E Schmader, Maren K Olsen, and Eugene Z Oddone.
• Center for Health Services Research in Primary Care, Veterans Affairs Medical Center, Durham, NC, USA. hasti003@mc.duke.edu
• Am J Manag Care. 2011 Jun 1; 17 (6 Spec No.): e215-23.

ObjectiveTo identify the frequency of, and risk factors for, repeat emergency department (ED) visits and hospitalizations following a treat-andrelease ED visit in patients from Veterans Affairs Medical Centers (VAMCs).Study DesignRetrospective cohort study.MethodsSubjects were veterans who visited 1 of 102 VAMC EDs between October 1, 2007, and June 30, 2008. Generalized estimating equations were used to identify factors related to repeat ED visits and hospitalizations within 30 days of the index ED visit.ResultsAt their index ED visit, 80% of veterans were treated and released. Of these, 15% returned to the ED and 5% were hospitalized in the next 30 days. In adjusted= models, factors associated with increased odds of repeat ED visits included homelessness (odds ratio [OR] 1.70; 95% confidence interval [CI] 1.59, 1.82) and having a previous ED visit (OR 1.66; 95% CI 1.58, 1.74). Odds of hospitalization were higher among older (OR 1.35; 95% CI 1.26, 1.46), homeless (OR 1.61; 95% CI 1.44,.,and functionally impaired (OR 1.52; 95% CI 1.35, 1.76) veterans, those with greater comorbidity (OR 1.31; 95% CI 1.27, 1.34), previous hospitalization (OR 2.48; 95% CI 2.28, 2.70), and an original ED visit related to a chronic condition (OR 1.30; 95% CI 1.23, 1.37). Among veterans who returned to the ED, 71.7% did not see another VA outpatient provider between their original and return visits.ConclusionsA substantial proportion of veterans treated and released from VAMC EDs returned to the ED or were hospitalized within 30 days.

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