# Improving Value through Comprehensive Episodes of Emergency Care for Veterans

> **NIH VA I01** · VETERANS HEALTH ADMINISTRATION · 2024 · —

## Abstract

Background: Through the Choice Act of 2014 and the Maintaining Internal Systems and Strengthening
Integrated Outside Networks (MISSION) Act of 2018, the Veterans Affairs (VA) health system has substantially
expanded its role as a purchaser of care with greatly increased opportunities for Veterans to receive care
outside VA and in the community. Emergency department (ED) visits and related hospitalizations now
represent the largest provision of community-based care, costing over $4 billion to VA in fiscal year 2021—
more than 5 times greater than the next category of community care—and with nearly 50% more ED use
compared to the previous year, but with uncertain return on that spending.
Significance: Current approaches are inadequate for understanding the overall value of ED care for Veterans.
Episode of care models, however, a central strategy for measuring population level utilization and quality
associated with the full treatment of an illness, are a promising method for characterizing Veteran ED care both
in the community and VA with the goal of identifying sources of variability and opportunities for improvement.
Yet these models are not available for ED care or for emergency conditions and concerns common to
Veterans.
Innovation & Impact: Our proposed research represents a departure from the status quo and previous
attempts to understand differences in ED practice patterns for Veterans receiving care. Our study will unlock
critical insight and substantially move the field forward by evaluating differences in resource use, quality, and
care fragmentation patterns indicating opportunities for improvement in emergency care delivery that ultimately
shorten the standard cycle of meaningful and successful interventions for widespread adoption within VA.
Specific Aims: (1) To define a set of highly promising ED-based episodes of care for common conditions
experienced by Veterans; (2) To assess resource use and quality in ED-based episodes of care beginning in
the VA vs community setting; (3) To evaluate care fragmentation within ED-based episodes of care in the VA
vs community setting.
Methodology: Using the national VA datamart, we will define care episodes beginning with the ED visit for
several important Veteran conditions: congestive heart failure, chest pain, chronic obstructive pulmonary
disease, pneumonia, and suicidality. Employing a technical expert panel with a modified Delphi method, we will
determine inclusion and exclusion criteria, standardize risk-adjustment methods, and establish the validity of
these episode definitions. Then, using national VA and non-VA Community Care data and the methodologies
developed in Aim 1, we will apply ED-based care episodes and test for differences in patient utilization and
quality. Finally, we will test for associations between Veteran resource use and quality as developed in Aim 2
with indicators of care fragmentation, an important opportunity for intervention, in Aim 3.
Next Steps/Implementation: Di...

## Key facts

- **NIH application ID:** 10747500
- **Project number:** 1I01HX003601-01A2
- **Recipient organization:** VETERANS HEALTH ADMINISTRATION
- **Principal Investigator:** Keith Eric Kocher
- **Activity code:** I01 (R01, R21, SBIR, etc.)
- **Funding institute:** VA
- **Fiscal year:** 2024
- **Award amount:** —
- **Award type:** 1
- **Project period:** 2024-04-01 → 2028-03-31

## Primary source

NIH RePORTER: https://reporter.nih.gov/project-details/10747500

## Citation

> US National Institutes of Health, RePORTER application 10747500, Improving Value through Comprehensive Episodes of Emergency Care for Veterans (1I01HX003601-01A2). Retrieved via AI Analytics 2026-06-23 from https://api.ai-analytics.org/grant/nih/10747500. Licensed CC0.

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