# Veteran Access to Emergency Care

> **NIH VA I01** · VETERANS ADMIN PALO ALTO HEALTH CARE SYS · 2020 · —

## Abstract

Significance: This project evaluates access to emergency care for Veterans with particular emphasis on:
assessing resources and capabilities of VA EDs to care for Veterans during times of crisis, determining where
care is provided (VA vs. non-VA EDs), and understanding how and why Veterans make decisions regarding
where to seek emergency care. The objectives of this proposal are directly responsive to HSRD priority areas
(Access and Health systems change) and three of the VA Breakthrough priority areas (Improve Access to
Health Care, Improve Community Care, and Improve the Veteran Experience). We also address Secretary
Shulkin's priority areas (Choice Act, improve infrastructure). Dr. Vashi and her team have strong ties to VA and
non-VA operational and policy partners, including the VA National Director of Emergency Medicine, which will
be instrumental in translating research findings into meaningful improvements in policy.
 Background and Innovation: Emergency care is a critical but understudied part of the continuum of
health care services offered to Veterans by the VA. While the VA is committed to providing timely and high-
quality emergency care, surprisingly little is known about Veteran access to acute care or about the quality of
care provided. Variations in VA emergency care resources are not well understood and prevent Veterans from
making informed choices. Moreover, eligibility for non-VA ED care is confusing, complex and can translate to
delays in treatment and poor outcomes. VA estimates that current VA users get, on average, only about 38%
of their ED visits from VA, yet no study to date has examined emergency care Veterans receive in non-VA
settings. While use of non-VA EDs may sometimes be appropriate, there are other times when the ED care
could have been provided at the VA and use of the non-VA ED may result in duplicative care and delays. This
dual use matters to the VA because, like an Accountable Care Organization, the VA is still responsible for the
overall health of the Veteran and often the expenses even when Veterans receive care outside of the VA.
 Aims: Objectives of this proposal are: (1) To create survey items that facilitate a comprehensive inventory
of VA ED resources and capabilities; (2) to calculate VA and non-VA ED utilization rates and identify the
patient, facility, and community-level predictors of VA ED use and VA reliance; and (3) to characterize
Veterans' preferences, resources and contextual factors that influence ED setting choice (i.e. VA, non-VA).
 Methods: We will build on pilot work and convene an advisory panel to create and add survey items to the
next ED survey to assess VA ED resources and capabilities and determine how they vary (e.g. region, rurality,
complexity). Using an innovative linkage method, we will use VA, Medicare, and California data to examine ED
use across groups. Further, we will assess the patient, facility, and community level predictors of Veterans'
choice of delivery system and...

## Key facts

- **NIH application ID:** 10134804
- **Project number:** 5I01HX002362-03
- **Recipient organization:** VETERANS ADMIN PALO ALTO HEALTH CARE SYS
- **Principal Investigator:** Anita A Vashi
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2020
- **Award amount:** —
- **Award type:** 5
- **Project period:** 2018-05-01 → 2023-11-30

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10134804

## Citation

> US National Institutes of Health, RePORTER application 10134804, Veteran Access to Emergency Care (5I01HX002362-03). Retrieved via AI Analytics 2026-05-23 from https://api.ai-analytics.org/grant/nih/10134804. Licensed CC0.

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