Associations Between Reduced Hospital Length of Stay and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals
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?
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.
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).
Over a 14-year period, hospitals in the Veterans Health Administration demonstrated simultaneous improvement in hospital LOS and 30-day readmission rates.
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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