{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,8]],"date-time":"2026-09-08T12:58:23Z","timestamp":1788872303320,"version":"build-2803163510"},"reference-count":72,"publisher":"Wiley","issue":"4","license":[{"start":{"date-parts":[[2023,3,21]],"date-time":"2023-03-21T00:00:00Z","timestamp":1679356800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Academic Emergency Medicine"],"published-print":{"date-parts":[[2023,4]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Objectives<\/jats:title><jats:p>Research examining emergency department (ED) admission practices within the Department of Veterans Affairs (VA) is limited. This study investigates facility\u2010level variation in risk\u2010standardized admission rates (RSARs) for emergency care\u2013sensitive conditions (ECSCs) among older (\u226565\u2009years) and younger (&lt;65\u2009years) Veterans across VA EDs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>Veterans presenting to a VA ED for an ECSC between October 1, 2016 and September 30, 2019 were identified and the 10 most common ECSCs established. ECSC\u2010specific RSARs were calculated using hierarchical generalized linear models, adjusting for Veteran and encounter characteristics. The interquartile range ratio (IQR ratio) and coefficient of variation were measures of dispersion for each condition and were stratified by age group. Associations with facility characteristics were also examined in condition\u2010specific multivariable models.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The overall cohort included 651,336 ED visits across 110 VA facilities for the 10 most common ECSCs\u2014chronic obstructive pulmonary disease (COPD), heart failure, pneumonia, volume depletion, tachyarrhythmias, acute diabetes mellitus, gastrointestinal (GI) bleeding, asthma, sepsis, and myocardial infarction (MI). After adjusting for case mix, the ECSCs with the greatest variation (IQR ratio, coefficient of variation) in RSARs were asthma (1.43, 32.12), COPD (1.39, 24.64), volume depletion (1.38, 23.67), and acute diabetes mellitus (1.28, 17.52), whereas those with the least variation were MI (1.01, 0.87) and sepsis (1.02, 2.41). Condition\u2010specific RSARs were not qualitatively different between age subgroups. Association with facility characteristics varied across ECSCs and within condition\u2010specific age subgroups.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>We identified unexplained facility\u2010level variation in RSARs for Veterans presenting with the 10 most common ECSCs to VA EDs. The magnitude of variation did not appear to be qualitatively different between older and younger Veteran subgroups. Variation in RSARs for ECSCs may be an important target for systems\u2010based levers to improve value in VA emergency care.<\/jats:p><\/jats:sec>","DOI":"10.1111\/acem.14691","type":"journal-article","created":{"date-parts":[[2023,2,10]],"date-time":"2023-02-10T13:36:51Z","timestamp":1676036211000},"page":"299-309","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Hospital\u2010level variation in risk\u2010standardized admission rates for emergency care\u2013sensitive conditions among older and younger Veterans"],"prefix":"10.1111","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2797-6682","authenticated-orcid":false,"given":"Christina M.","family":"Cutter","sequence":"first","affiliation":[{"name":"Department of Emergency Medicine University of Michigan  Ann Arbor Michigan USA"},{"name":"Department of Veterans Affairs VA Ann Arbor Healthcare System  Ann Arbor Michigan USA"},{"name":"Institute for 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