{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,23]],"date-time":"2026-04-23T08:12:00Z","timestamp":1776931920186,"version":"3.51.2"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5-6","license":[{"start":{"date-parts":[[2021,5,1]],"date-time":"2021-05-01T00:00:00Z","timestamp":1619827200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"funder":[{"name":"U.S. DoD, Defense Health Agency","award":["HU0001-11-1-0023"],"award-info":[{"award-number":["HU0001-11-1-0023"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,5,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n               <jats:sec>\n                  <jats:title>Introduction<\/jats:title>\n                  <jats:p>Emergency department (ED) utilization represents an expensive and growing means of accessing care for a variety of conditions. Prior studies have characterized ED utilization in the general population. We aim to identify the clinical conditions that drive ED utilization in a universally insured population and the impacts of care setting on ED use and admissions in the U.S. Military Health System.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>We queried TRICARE claims data from October 1, 2012, to September 30, 2015, to identify all ED visits for adult patients (age 18-64). The primary presenting diagnoses of all ED visits and those leading to admission are presented with descriptive statistics. Logistic regression was used to identify clinical and sociodemographic factors associated with admission from the ED.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>A total of 4,687,205 ED visits were identified, of which 46% took place in the DoD healthcare facilities (direct care). The most common diagnoses across all ED visits were abdominal pain, chest pain, headache, nausea and vomiting, and urinary tract infection. A total of 270,127 (5.8%) ED visits led to inpatient admission. The most common diagnoses leading to admission were chest pain, abdominal pain, depression, conditions relating to acute psychological stress, and pneumonia. For patients presenting with 1 of the 10 most common ED diagnoses, those who were seen at a civilian ED were significantly less likely to be admitted (3.4%) compared to direct care facilities (4.1%) in an adjusted logistic regression model (Adjusted Odds Ratio 0.40 [95% CI: 0.40-0.41], P\u2009&amp;lt;\u2009.001).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusions<\/jats:title>\n                  <jats:p>Ultimately, we show that abdominal pain and chest pain are the most common reasons for presentation to the ED in the Military Health System and the most common presenting diagnoses for admission from the ED. Among patients presenting with the most common ED conditions, direct care EDs were significantly more likely to admit patients than civilian facilities.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1093\/milmed\/usaa547","type":"journal-article","created":{"date-parts":[[2020,12,18]],"date-time":"2020-12-18T20:44:18Z","timestamp":1608324258000},"page":"606-612","source":"Crossref","is-referenced-by-count":3,"title":["Emergency Department Utilization in the U.S. Military Health System"],"prefix":"10.1093","volume":"186","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-4526-3253","authenticated-orcid":false,"suffix":"MD, MPH","given":"Michael K","family":"Dalton","sequence":"first","affiliation":[{"name":"Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3873-6446","authenticated-orcid":false,"suffix":"MD, MPH","given":"Tomas","family":"Andriotti","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"BS","given":"Bridget","family":"Matsas","sequence":"additional","affiliation":[{"name":"Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Muhammad Ali","family":"Chaudhary","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Laura","family":"Tilley","sequence":"additional","affiliation":[{"name":"F. Edward H\u00e9bert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"ScD","given":"Stuart","family":"Lipsitz","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, MA 02120, USA"},{"name":"Division of General Internal Medicine, Brigham and Women\u2019s Hospital and Harvard Medical School, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD","given":"Peter A","family":"Learn","sequence":"additional","affiliation":[{"name":"F. Edward H\u00e9bert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD, MSc","given":"Andrew J","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"PhD, MPH","given":"Molly P","family":"Jarman","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, MA 02120, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"suffix":"MD, MS","given":"Eric","family":"Goralnick","sequence":"additional","affiliation":[{"name":"Center for Surgery and Public Health, Harvard Medical School, Harvard T. H. Chan School of Public Health, Department of Surgery, Brigham and Women\u2019s Hospital, Boston, MA 02120, USA"},{"name":"Department of Emergency Medicine, Brigham and Women\u2019s Hospital, Boston, MA 02115, USA"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[2021,5,3]]},"reference":[{"issue":"6","key":"2021050314024597300_R1","doi-asserted-by":"publisher","first-page":"664","DOI":"10.1001\/jama.2010.1112","article-title":"Trends and characteristics of US emergency department visits, 1997-2007","volume":"304","author":"Tang","year":"2010","journal-title":"JAMA"},{"issue":"2","key":"2021050314024597300_R2","doi-asserted-by":"publisher","first-page":"106","DOI":"10.1111\/jnu.12055","article-title":"The relationship between emergency department crowding and patient outcomes: a systematic review","volume":"46","author":"Carter","year":"2014","journal-title":"J Nurs Scholarsh"},{"issue":"3","key":"2021050314024597300_R3","doi-asserted-by":"publisher","first-page":"265","DOI":"10.1016\/0735-6757(94)90135-X","article-title":"Increased health care costs associated with ED overcrowding","volume":"12","author":"Krochmal","year":"1994","journal-title":"Am J Emerg Med"},{"issue":"2","key":"2021050314024597300_R4","doi-asserted-by":"publisher","first-page":"151","DOI":"10.1111\/j.1553-2712.2001.tb01280.x","article-title":"Frequent overcrowding in U.S. emergency departments","volume":"8","author":"Derlet","year":"2001","journal-title":"Acad Emerg Med"},{"key":"2021050314024597300_R5","article-title":"Preventable ED use costs $8.3 billion annually: analysis","volume-title":"Healthcare Financial Management Association (HFMA)","author":"Daly","year":"2019"},{"issue":"5","key":"2021050314024597300_R6","doi-asserted-by":"publisher","first-page":"429","DOI":"10.1016\/j.jen.2005.06.023","article-title":"Patients\u2019 perspective on choosing the emergency department for nonurgent medical care: a qualitative study exploring one reason for overcrowding","volume":"31","author":"Howard","year":"2005","journal-title":"J Emerg Nurs"},{"issue":"1","key":"2021050314024597300_R7","first-page":"47","article-title":"Emergency department visits for nonurgent conditions: systematic literature review","volume":"19","author":"Uscher-Pines","year":"2013","journal-title":"Am J Manag Care"},{"key":"2021050314024597300_R8","volume-title":"Emergency room use among adults aged 18-64: early release of estimates from the National Health Interview Survey, January\u2013June 2011","author":"Gindi","year":"2012"},{"issue":"6","key":"2021050314024597300_R9","doi-asserted-by":"publisher","first-page":"893","DOI":"10.1007\/s11739-018-1792-3","article-title":"Non-urgent use of emergency departments: populations most likely to overestimate illness severity","volume":"13","author":"Andrews","year":"2018","journal-title":"Intern Emerg Med"},{"issue":"9","key":"2021050314024597300_R10","doi-asserted-by":"publisher","first-page":"1291","DOI":"10.1016\/j.ajem.2017.03.074","article-title":"The relative contribution of provider and ED-level factors to variation among the top 15 reasons for ED admission","volume":"35","author":"Khojah","year":"2017","journal-title":"Am J Emerg Med"},{"issue":"11","key":"2021050314024597300_R11","doi-asserted-by":"publisher","first-page":"1145","DOI":"10.1001\/jama.2013.1948","article-title":"Comparison of presenting complaint vs discharge diagnosis for identifying \u201cnonemergency\u201d emergency department visits","volume":"309","author":"Raven","year":"2013","journal-title":"JAMA"},{"issue":"11","key":"2021050314024597300_R12","doi-asserted-by":"publisher","first-page":"1173","DOI":"10.1001\/jama.2013.2476","article-title":"Emergency department overuse: perceptions and solutions","volume":"309","author":"Adams","year":"2013","journal-title":"JAMA"},{"key":"2021050314024597300_R13","article-title":"Trends in Hospital Emergency Department Visits by Age and Payer, 2006-2015. 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