VA Connecticut Healthcare System
Psychology Service

Author Of 1 Presentation

Comorbidities Poster Presentation

P0448 - Comorbidities as predictors of all-cause emergency room usage in multiple sclerosis (ID 1345)

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Certain comorbidities have been identified as being associated with hospitalization rates among persons with multiple sclerosis (MS); however, to date, there is limited information on their relationship with all-cause emergency room (ER) usage, which can be financially burdensome.


1) To determine if the presence of comorbidities increases the odds of ER usage and 2) examine if certain groups of comorbidities are associated with utilization.


Data were extracted from the VA MS Center of Excellence Data Repository, which includes electronic health record-based information from US Veterans receiving services at any Veterans Affairs (VA) medical center. CPT codes were used to determine if Veterans had at least one ER visit during a 24-month time frame. Comorbidities were identified using ICD-9 codes present prior to 2013, and were grouped by ICD-9 category, with the exception of traumatic brain injuries (TBI), pain disorders, and sleep disorders, which were separate categories. Separate logistic regressions were conducted for the overall number of comorbidities and categorized comorbidities, controlling for age and gender.


Nearly 32% (n = 1,191) had at least one ER visit, with those Veterans having an average of 6.67 ± 3.32 comorbidities. After controlling for age and gender, the number of comorbidities was a significant predictor of ER usage (odds ratio [OR]: 1.21). The odds of ER usage were higher among Veterans with co-occurring TBIs (OR: 1.62), pain (OR: 1.60), circulatory (OR: 1.50), nervous system and sense organ (OR: 1.48), digestive (OR: 1.46), neoplasms (OR: 1.42), respiratory (OR: 1.32), mental (OR: 1.32), and sleep disorders (OR: 1.20).


All-cause ER utilization is prevalent among Veterans with MS, with usage increasing in the presence of other chronic comorbidities. These findings underscore the need to view long-term MS care through the lens of chronic disease management and suggest that addressing comorbidities may be important to reduce all-cause emergency care, through such critical strategies as preventive and health promotion programs (e.g., physical activity for pain and circulatory disorders), self-management (e.g., patient activation and engagement in care), and increased coordination among healthcare providers of key disorders to optimize and reinforce good care.