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Although homeless-tailored primary care clinics receive more favorable patient ratings, it remains unclear whether patient experience or clinic type predicts future ED use.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To identify clinical and social predictors of high ED utilization among homeless-experienced veterans (HEVs) and to test whether (a) unfavorable care ratings predict higher ED use and (b) care in homeless-tailored primary care clinics predicts lower ED use compared with mainstream clinics.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design<\/jats:title>\n                    <jats:p>A retrospective cohort study linking national survey data with electronic health record data was conducted to assess ED utilization during the 1-year following survey completion.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Participants<\/jats:title>\n                    <jats:p>Five thousand seventy-nine HEVs engaged in Veterans Health Administration primary care who completed the 2018 Primary Care Quality\u2013Homeless Services Tailoring (PCQ-HoST) survey.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Measures<\/jats:title>\n                    <jats:p>Primary care type (homeless-tailored or mainstream), patient-reported primary care experience on a validated survey, and ED utilization (defined as high based on four or more visits).\u00a0<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Key Results<\/jats:title>\n                    <jats:p>Among 5079 HEVs, 474 (9.3%) had high ED utilization. High utilization was associated with current and chronic homelessness, chronic pain, medical and psychiatric comorbidities, and substance use disorders. An unfavorable primary care experience was associated with higher odds of subsequent high ED utilization (OR 1.31; 95% CI 1.26\u20131.68). Primary care clinic type was not independently associated with high ED utilization.\u00a0In post hoc count-based models, care in a homeless-tailored clinic was associated with 0.15 fewer ED visits annually.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Among HEVs engaged in primary care, high ED utilization is driven primarily by clinical complexity and housing instability. However, an unfavorable patient-reported primary care experience was independently associated with subsequent ED use, suggesting that improving primary care interactions may contribute to broader efforts to address high ED utilization in this population.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1007\/s11606-026-10471-x","type":"journal-article","created":{"date-parts":[[2026,5,14]],"date-time":"2026-05-14T15:56:06Z","timestamp":1778774166000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Patient and Primary Care Characteristics Associated with Emergency Department Utilization Among Homeless-Experienced Veterans"],"prefix":"10.1007","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-0067-4788","authenticated-orcid":false,"given":"Erin F.","family":"Shufflebarger","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Aerin J.","family":"deRussy","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"April E.","family":"Hoge","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Kevin R.","family":"Riggs","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lillian","family":"Gelberg","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Adam J.","family":"Gordon","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Audrey L.","family":"Jones","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joshua S.","family":"Richman","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ann Elizabeth","family":"Montgomery","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Allyson L.","family":"Varley","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Stefan G.","family":"Kertesz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2026,5,14]]},"reference":[{"key":"10471_CR1","unstructured":"CDC National Center for Health Statistics. 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Participants were informed that by answering the survey they were agreeing to participate in the research study, so additional signed informed consent was not obtained.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethics Approval and Consent to Participate"}},{"value":"Dr. Riggs was supported by a career development award from the National Institute of Arthritis and Musculoskeletal and Skin Diseases.\u00a0Dr. Jones was supported by a career development award from VA Health Services Research & Development.\u00a0Dr. Kertesz reports current ownership of health-related stocks: Thermo Fisher, and past-year ownership of stock from DexCom. He receives royalties from Wolters-Kluwer, Inc, publisher of UpToDate. Dr. Varley is also employed with Heart Rhythm Clinical and Research Solutions. None has any financial interest in this work and is directly relevant to the subject of this manuscript.\u00a0All authors were financially affiliated with the United States Department of Veterans Affairs through employment or contract during the preparation of this manuscript. There are no other conflicts of interest relevant to the work under consideration.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"The views expressed in this manuscript are those of the authors alone and do not represent formal\u00a0positions or views of the United States Department of Veterans Affairs.","order":4,"name":"Ethics","group":{"name":"EthicsHeading","label":"Disclaimer"}}]}}