{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,5]],"date-time":"2026-05-05T23:10:29Z","timestamp":1778022629753,"version":"3.51.4"},"reference-count":30,"publisher":"Oxford University Press (OUP)","issue":"5-6","funder":[{"DOI":"10.13039\/100000738","name":"Department of Veterans Affairs","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100000738","id-type":"DOI","asserted-by":"publisher"}]},{"name":"Department of Veterans Affairs Office of Integrated Veteran Care"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2026,5,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Introduction<\/jats:title>\n                    <jats:p>Persistent frequent emergency department (ED) use may signal unmet medical, behavioral, and social needs. Understanding patterns of persistence and associated risk factors can inform ED-based interventions and care coordination strategies. This study aimed to examine patterns of frequent ED use, identify predictors of persistence, and assess frequent community ED users as a policy-relevant subgroup.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Materials and Methods<\/jats:title>\n                    <jats:p>We conducted a national longitudinal cohort study of Veterans Health Administration (VA) enrollees from 2018 to 2022 using administrative data on ED visits across VA and non-VA (community) settings. Frequent ED use was defined as \u22654 visits in a year. We assessed the proportion of frequent users with persistent high utilization over 3 and 5 years, evaluated sociodemographic, clinical, and system-level predictors of persistence, and calculated 5-year mortality rates. Sensitivity analyses examined patterns and outcomes among frequent community ED users.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>Annually, 12-13% of VA enrollees met criteria for frequent ED use. Among 174,510 veterans with frequent ED use in 2018, 14% remained frequent utilizers at 3 years and 5% at 5 years, indicating substantial turnover. The most common primary diagnoses among frequent users were chest pain, low back pain, urinary tract infection, suicide\/intentional self-harm, and chronic obstructive pulmonary disease. Predictors of persistence included Black race, medical and mental health comorbidities, and higher baseline ED use. Five-year mortality among frequent ED users was 24%. Among frequent community ED users, only 3% remained frequent users, yet their 5-year mortality rate approached 40%.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>Although most Veterans cycle out of high ED use, those with persistent use face high mortality. These findings highlight the importance of early identification and risk stratification to guide ED-based care management, behavioral health integration, and end-of-life planning for vulnerable populations.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1093\/milmed\/usaf479","type":"journal-article","created":{"date-parts":[[2025,9,13]],"date-time":"2025-09-13T11:45:16Z","timestamp":1757763916000},"page":"e1217-e1225","source":"Crossref","is-referenced-by-count":0,"title":["Persistent Emergency Department Use Among Veterans: Longitudinal Patterns and Opportunities for Targeted Intervention"],"prefix":"10.1093","volume":"191","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6305-6779","authenticated-orcid":false,"given":"Anita A","family":"Vashi","sequence":"first","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Department of Emergency Medicine, University of California, San Francisco , San Francisco, CA 94110,","place":["United States"]},{"name":"Department of Emergency Medicine (Affiliated), Stanford University , Stanford, CA 94305,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Selen","family":"Bozkurt","sequence":"additional","affiliation":[{"name":"Department of Biomedical Informatics, Emory University School of Medicine , Atlanta, GA 30322,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6512-3480","authenticated-orcid":false,"given":"Tracy","family":"Urech","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Siqi","family":"Wu","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Division of Primary Care and Population Health, Stanford Medicine, Stanford University , Stanford, CA 94305,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Steven M","family":"Asch","sequence":"additional","affiliation":[{"name":"Center for Innovation to Implementation, VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Division of Primary Care and Population Health, Stanford Medicine, Stanford University , Stanford, CA 94305,","place":["United States"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Linda Diem","family":"Tran","sequence":"additional","affiliation":[{"name":"Health Economics Resource Center, VA Palo Alto Health Care System , Menlo Park, CA 94025,","place":["United States"]},{"name":"Surgery Policy Improvement and Education Center, Stanford Medicine, Stanford University , Stanford, CA 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