Table 4. Association Between Levels of Continuity of Care and Emergency Department Utilization for Patients with ≥1 Continuity Visit.
| Adjusted Rates of ED Utilizationa | ||
| Variables | Visits/1000 PY (95% CI) | p-value |
| Continuity of care level | ||
| Low (<33%)b | 662 (407, 1076) | - |
| Medium (33–50%) | 585 (298, 1148) | 0.20 |
| High (>50%) | 533 (276, 1031) | 0.01 |
| Adjusted Odds of ED Utilization a | ||
| Variables | AOR (95% CI) | p-value |
| Continuity of care level | ||
| Low (<33%)b | 1.00 | |
| Medium (33–50%) | 0.70 (0.54, 0.92) | <0.001 |
| High (>50%) | 0.59 (0.25, 0.76) | <0.001 |
| Age/10 | 0.91 (0.84, 0.99) | 0.02 |
| Male | 0.96 (0.78, 1.20) | 0.74 |
| Comorbidities | ||
| Smoker | 1.24 (1.10, 1.39) | <0.001 |
| Substance use disorder | 1.74 (1.48, 2.04) | <0.001 |
| Severe mental illness | 1.30 (1.12, 1.51) | <0.001 |
| MI/Coronary artery disease | 1.19 (1.06, 1.34) | 0.003 |
| Congestive heart failure | 2.36 (1.89, 2.95) | <0.001 |
| Diabetes mellitus | 1.18 (1.06, 1.31) | 0.003 |
| Hypertension | 1.03 (0.92, 1.15) | 0.63 |
| Peripheral vascular disease | 1.08 (0.89, 1.31) | 0.41 |
| Pulmonary disorder/COPD | 1.68 (1.47, 1.92) | <0.001 |
| Stroke/TIA | 1.54 (1.26, 1.90) | <0.001 |
| Hyperlipidemia | 0.83 (0.75, 0.92) | <0.001 |
| Flu | 1.09 (0.99, 1.20) | 0.08 |
| Obesity | 0.96 (0.84, 1.09) | 0.49 |
| Primary care user level | ||
| High (≥3 visits/year)b | 1.00 | |
| Low (<3 visits/year) | 0.28 (0.26, 0.32) | <0.001 |
| Outside insurance | 0.87 (0.77, 0.98) | 0.02 |
| Service connection (%) | ||
| >75%b | 1.00 | |
| 51–75% | 0.82 (0.65, 1.04) | 0.10 |
| <50% | 0.69 (0.59, 0.80) | <0.001 |
| Service Period | ||
| Vietnam Warb | 1.00 | |
| Otherc | 1.14 (0.82, 1.57) | 0.44 |
| Korean War | 1.00 (0.83, 1.21) | 0.97 |
| Persian Gulf War | 0.97 (0.75, 1.26) | 0.85 |
| Post-Korean War Period | 0.89 (0.73, 1.09) | 0.25 |
| Post-Vietnam Period | 1.34 (1.12, 1.61) | 0.002 |
| World War II | 1.39 (1.10, 1.74) | 0.005 |
| Assigned provider(s) | ||
| PCP onlyb | 1.00 | |
| Trainee & PCP | 0.82 (0.72, 0.93) | 0.002 |
| Zip code distance from ED | ||
| ≤2b | 1.00 | |
| 3–5 | 1.06 (0.90, 1.25) | 0.48 |
| 6–10 | 1.09 (0.74, 1.59) | 0.67 |
| 11–50 | 0.55 (0.47, 0.64) | <0.001 |
| >50 | 0.59 (0.52, 0.66) | <0.001 |
Abbreviations: ED, emergency department; PY, person-year; CI, confidence interval; IQR, interquartile range; OR, odds ratio; AOR, adjusted odds ratio; COPD, chronic obstructive pulmonary disease; TIA, transient ischemic attack; PTSD, post-traumatic stress disorder; ED, emergency department; PCP, primary care provider.
a
The adjusted model excluded 1289 (9.6%) patients because they were missing one or more variables in the model.
b
Reference value.
c
Because of the small number of veterans in these groups, they were combined: active military personnel, CAV/NPS, ChampVA spouse and children, non-Veteran humanitarian groups, merchant marines, and Tricare.