skip to page content
Talk to the Veterans Crisis Line now
U.S. flag
An official website of the United States government

Health Systems Research

Go to the VA ORD website
Go to the QUERI website

PPO 18-258 – HSR Study

PPO 18-258
Assessing Feasibility of Measuring Veterans' Experiences and Receipt of Follow-Up Care after VA Emergency Department Treat-and-Release Visits
Kristina M Cordasco, MD MPH MSHS
VA Greater Los Angeles Healthcare System, West Los Angeles, CA
West Los Angeles, CA
Funding Period: February 2020 - September 2021


Multiple studies have documented that poor communication across care transitions leads to medical errors, adverse clinical outcomes, inefficient care, and less favorable patient experiences. However, relatively little attention has been given to the transition between emergency department (ED) and follow-up care for patients discharged directly from the ED. Patients discharged from EDs may have one or more urgent follow-up care needs, such as repeat laboratory assessments, specialty care consultations, and specialized diagnostic testing. Available literature suggests that failures to receive follow-up care after being sent home from ED visits are a crucial patient safety issue. Inadequate communication and coordination of follow-up care recommendations may be leading to such failures. Veterans make approximately 2 million visits to VA EDs each year, and are discharged from the ED nearly 80% of the time. Patients presenting to VA EDs generally have complex medical histories, and therefore are at particularly high risk for experiencing adverse outcomes. Among a cohort of 942 Veterans 65 years of age or older discharged from the Durham VA ED in 2003, 34% had a return ED visit, were hospitalized and/or died within 90 days. Despite this vulnerability, knowledge is scant and outdated about whether Veterans receive the post-ED care they need to prevent these adverse outcomes, and no assessments have been done regarding Veterans’ experiences obtaining this care. Tools for assessing Veterans’ experiences with this care transition are needed. Further, VA operations and QUERI-funded projects have been initiated targeting this transition in VA, and tools are needed to enable rigorous assessment of their effectiveness. This project will develop and test a patient survey to measure the quality of communication and care coordination for this transition. Since ambulatory care can prevent initial chronic disease exacerbations needing ED visits, it is a reasonable extrapolation that ambulatory care follow-up after ED visits could prevent re-exacerbations and ED re-visits. Therefore, this work will focus on Veterans with ED visits for chronic ambulatory care sensitive conditions (ACSCs): 1) asthma, 2) congestive heart failure, 3) chronic obstructive pulmonary disease, 4) diabetes mellitus, and 5) hypertension, since we postulate that these patients are most likely to have follow-up care needs. Given that there is also scant literature on the ED follow-up care needs of patients with ACSCs, the work will begin with characterizing the specific follow-up care needs of these patients using record review. Then, semi-structured interviews will be conducted to investigate patient-centered perspectives on critical components of post-ED care, asking Veterans about their communication and care coordination experiences. Interviews will be analyzed to assess which aspects of communication and coordination are most important for Veterans’ post-ED experiences as well as other factors (e.g., facilitators and barriers to receiving care) relevant to Veterans’ experiences of post-ED care. Finally, these findings will be used to develop and assess content validity of a survey instrument to assess the extent to which Veterans are receiving needed post-ED care, and Veterans’ experiences with this care transition. This survey instrument will be used in subsequent research proposals addressing VA priority areas (e.g. improving care timeliness, focusing resources efficiently), including determining the quality of VA ED follow-up care and assessing the effectiveness of improvement interventions.

External Links for this Project

NIH Reporter

Grant Number: I21HX002799-01A1

Dimensions for VA

Dimensions for VA is a web-based tool available to VA staff that enables detailed searches of published research and research projects.

Learn more about Dimensions for VA.

VA staff not currently on the VA network can access Dimensions by registering for an account using their VA email address.
    Search Dimensions for this project


Journal Articles

  1. Cordasco KM, Gable AR, Tan GJ, Yuan AH, Yip K, Khafaf M, Hays RD, Faiz JP, Chawla N, Ganz DA. Veteran knowledge, perceptions, and receipt of care following visits to VA emergency departments for ambulatory care sensitive conditions. Academic emergency medicine : official journal of the Society for Academic Emergency Medicine. 2023 Apr 1; 30(4):252-261. [view]
  2. Cordasco KM, Yuan AH, Rollman JE, Moreau JL, Edwards LK, Gable AR, Hsiao JJ, Ganz DA, Vashi AA, Mehta PA, Jackson NJ. Veterans' Use of Telehealth for Veterans Health Administration Community Care Urgent Care During the Early COVID-19 Pandemic. Medical care. 2022 Nov 1; 60(11):860-867. [view]

DRA: Health Systems
DRE: TRL - Applied/Translational
Keywords: Care Coordination, Outcomes - System, Quality Improvement
MeSH Terms: None at this time.

Questions about the HSR website? Email the Web Team

Any health information on this website is strictly for informational purposes and is not intended as medical advice. It should not be used to diagnose or treat any condition.