Intensive Care Unit Admissions Purchased or Delivered by Veterans in the VA Health Care System

How did veteran intensive care unit (ICU) admission volume, patient complexity, spending, and 90-day mortality differ between Veterans Affairs (VA) medical centers and community hospitals following the VA MISSION (Maintaining Internal Systems and Strengthening Integrated Outside Networks) Act and during the COVID-19 pandemic?In this cross-sectional study of a national cohort of 1 151 915 veteran ICU admissions from 2019 to 2023, VA medical center ICU admissions decreased by 21.3%, while community ICU use increased by 46.8%. The shift toward community ICU care was associated with higher acuity, increased 90-day mortality, and a 50% increase in spending.Results of this study suggest that careful reassessment of how VA and community ICU resources are balanced to ensure high-quality, sustainable critical care for veterans is warranted.

Corresponding Author: Florian B. Mayr, MD, MPH, VA Pittsburgh Healthcare System, University Drive C, Pittsburgh, PA 15240 (florian.mayr@pitt.edu).

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