Continuing the transformation: charting the path for the future delivery of Veteran emergency care

Abstract

Important changes in the delivery of Veteran emergency care in the early 2000s in the Department of Veteran Affairs (VA) emergency departments and urgent care clinics substantially elevated the role of emergency medicine (EM) in Veteran health care. Focused on enhancing the quality of care, emergency care visits in both VA and non-VA (community) care locations have nearly doubled from the 1980s to more than 3 million visits in Fiscal Year 2022. Recognizing the need to plan for continued growth and the opportunity to address key research priorities, the VA Office of Emergency Medicine, together with the VA Health Services Research and Development Service, collaborated to convene a State of the Art Conference on Veteran Emergency Medicine (SAVE) in the winter of 2022. The goal of this conference was to identify research gaps and priorities for implementation of policies for three priority groups: geriatric Veterans, Veterans with mental health and substance use complaints, and Veterans presenting to non-VA (community) emergency care sites. In this article we discuss the rationale for the SAVE conference including a brief history of VA EM and the planning process and conclude with next steps for findings from the conference.

Community Emergency Care Use by Veterans in an Era of Expanding Choice

“…1 To serve the acute care needs of its population, the VA has developed an emergency care system that provides acute, unscheduled care across 110 emergency departments (EDs). 2 Accessing emergency care is challenging for veterans who rely on the VA for health care, particularly in rural and underserved areas, in part because of the limited geographic reach of the VA emergency care system. One solution to mitigate this access challenge has been to purchase care in the private, or non-VA, sector, thereby allowing eligible veterans to use their benefits outside the VA for treatment services delivered by practitioners in closer proximity.…”

“…Emergency care has emerged as the primary contributor to VA community care spending, with community ED visit expenditures rising by 46% since 2020. 2 With its dual role as a source and purchaser, the VA is faced with new challenges in delivering and coordinating acute care services across multiple settings. For veterans, use of both VA and community ED care may lead to duplicative and/or inefficient care, medical errors, adverse clinical outcomes, and less favorable patient experiences.…”

“…The Veterans Affairs (VA) Health Care System serves as the largest publicly financed integrated national health care system in the US, treating over 9 million patients through an extensive network of over 1300 facilities . To serve the acute care needs of its population, the VA has developed an emergency care system that provides acute, unscheduled care across 110 emergency departments (EDs) …”

Research and policy recommendations from the SOTA XVI: State of the Art Conference on VA Emergency Medicine

“…In recent years, the U.S. Department of Veterans Affairs (VA) has increased resources, services, and capabilities to meet the acute care needs of Veterans 1 . Establishing research and policy priorities is needed to enhance the impact of emergency care on Veteran health.…”

“…In recent years, the U.S. Department of Veterans Affairs (VA) has increased resources, services, and capabilities to meet the acute care needs of Veterans. 1 Establishing research and policy priorities is needed to enhance the impact of emergency care on Veteran health. Given the breadth of clinical problems seen in EDs, the planning committee sought to narrow the focus of the SAVE conference and to work with HSR&D to achieve consensus around priority groups.…”