Associations Between Reduced Hospital Length of Stay and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals

Mar 01, 2013
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Authors:
Kaboli PJ, Go JT, Hockenberry J, et al.
Citation:
Ann Intern Med 2012;157:837-845.
Summary By:
Prashant Vaishnava, MD, FACC

Study Questions:

What are trends in hospital length of stay (LOS) and 30-day readmission rates for all medical diagnoses combined and Five specific diagnoses—heart failure (HF), chronic obstructive pulmonary disease, acute myocardial infarction (AMI), community-acquired pneumonia, and gastrointestinal hemorrhage—among hospitals in the Veterans Health Administration?

Methods:

This was an observational study conducted between 1997 and 2010 among all 129 acute care Veterans Affairs hospitals in the United States. Primary outcomes were hospital LOS and 30-day readmission rates. Multivariable regression analyses were used to adjust for patient demographic characteristics, comorbid conditions, and admitting hospitals.

Results:

The final cohort consisted of 4,124,907 admissions over 14 years of observation. For all medical diagnoses combined, risk-adjusted mean hospital LOS decreased by 1.46 days from 5.44 to 3.98 days, or 2% annually (p < 0.001). Risk-adjusted 30-day readmission rates for all medical diagnoses combined decreased from 16.5% to 13.8% (p < 0.001).

Conclusions:

Over a 14-year period, hospitals in the Veterans Health Administration demonstrated simultaneous improvement in hospital LOS and 30-day readmission rates.

Perspective:

The current analysis provides some reassurance that improvements in hospital LOS are not undone by increases in hospital readmission rates among 129 Veterans Affairs hospitals and more than 4 million admissions spanning 14 years. However, there may still be a tradeoff between efficiency and quality, as hospitals with mean risk-adjusted LOS that was lower than expected had a higher readmission rate. The complicated relationships between LOS, preventable readmissions, and processes/transitions of care warrant continued exploration.

Keywords: Myocardial Infarction, Pneumonia, Cardiology, Gastrointestinal Hemorrhage, United States Department of Veterans Affairs, Hospitalization, United States, Lung Diseases, Length of Stay


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