Where Women Veterans Seek Emergency Care: Patterns and Predictors of VA and Community Emergency Department Use

Abstract Background Women using Veterans Health Administration (VA) facilities have nearly doubled over the past decade. Women Veterans have distinct emergency care needs across their lifespan; examining care setting (VA versus non-VA, hereafter Community Care) can inform service planning. Despite ongoing improvement efforts, there has not been a recent comprehensive, national assessment of emergency care utilization patterns among women Veterans. Objective We sought to describe women Veterans’ emergency department (ED) utilization across VA-provided and VA Community Care settings, identify predictors of setting, and compare patterns to that of men Veterans. Design, Participants, Main Measures We conducted a retrospective cohort study of VA enrollees with at least one ED visit (VA-provided or Community Care) from 10/2022 to-9/2023. Patient- and visit-level characteristics were derived from VA administrative data. Descriptive statistics compared characteristics by sex. Among women Veterans, logistic regression with generalized estimating equations identified predictors of receiving VA-provided versus Community Care ED care. Key Results Among 1.6 million Veterans with ED visits, most ED visits by women occurred at VA sites (60%). In adjusted models, women had higher odds of using VA EDs for low acuity (OR 1.62, 95% CI 1.59–1.64) and behavioral health conditions (OR 1.10, 95% CI 1.06–1.14). Racially and ethnically minoritized women had greater odds of using VA EDs than White women. VA ED use was less likely among women experiencing homelessness (OR 0.90, 95% CI 0.86–0.93), with emergency care-sensitive conditions (OR 0.61, 95% CI 0.60–0.63), or living farther from VA EDs. Conclusions While a majority of women Veterans—particularly those with complex medical, mental health, and social needs—continue to rely on VA EDs for care, two-fifths utilize Community Care EDs with geographic distance and visit acuity being drivers. Findings underscore the need to improve care coordination and ensure that both VA and community ED providers are equipped to meet the diverse needs of women Veterans.