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Mortality and Readmission Rates in VA vs. Non-VA Hospitals
Study Questions:
What are the differences in mortality and readmission rates among men with acute myocardial infarction (AMI), heart failure (HF), or pneumonia hospitalized at Veterans Affairs (VA) and non-VA hospitals?
Methods:
This was a cross-sectional analysis of male Medicare fee-for-service beneficiaries ages 65 years or older hospitalized between 2000 and 2013 in VA and non-VA acute care hospitals for AMI, HF, or pneumonia. VA and non-VA hospitals within the same metropolitan statistical area were studied. Outcomes were all-cause 30-day mortality following an index hospitalization for AMI, HF, or pneumonia; and 30-day all-cause unplanned readmission rate.
Results:
The authors studied 104 VA and 1,513 non-VA hospitals. After risk-adjustment, VA hospitals had lower mortality rates than non-VA hospitals for AMI (13.52%; 95% confidence interval [CI], 13.38%-13.66% vs. 13.69%; 95% CI, 13.64%-13.74%) and HF (11.43%; 95% CI, 11.11%-11.75% vs. 11.87%; 95% CI, 11.80%-11.93%); p < 0.03 for both. For pneumonia, VA hospitals had higher mortality rates than non-VA hospitals (12.63%; 95% CI, 12.19%-13.07% vs. 12.17%; 95% CI, 12.08%-12.26%), p = 0.045. VA hospitals had higher readmission rates than non-VA hospitals for all three conditions. For AMI, the readmission rates were 17.84% (95% CI, 17.71%-17.96%) for VA hospitals vs. 17.21% (95% CI, 17.17%-17.25%) for non-VA hospitals; for HF, 24.66% (95% CI, 24.31%-25.02%) vs. 23.46 (95% CI, 23.99%-23.53%); and for pneumonia, 19.44% (95% CI, 19.19%-19.69%) vs. 18.68% (95% CI, 18.63%-18.73%), p < 0.001 for all.
Conclusions:
Compared to older men with AMI and HF at non-VA hospitals, those at VA hospitals had lower 30-day risk-standardized mortality rates. However, risk-standardized all-cause readmission rates were higher for all three conditions for older men hospitalized at VA hospitals, compared to those at non-VA hospitals. Absolute differences were small.
Perspective:
This is a valuable study that provides information on the comparative performance of VA and non-VA Hospitals. While the differences in mortality and readmission rates between the VA and non-VA hospitals are likely the result of an interplay of several factors, better survival in men at VA hospitals may reflect the implementation of quality improvement efforts across the VA-integrated delivery system. The differences in readmission rates may be explained, in part, by the Centers for Medicare & Medicaid Services Hospital Readmission Reduction Program, which imposes penalties for non-VA hospitals.
Clinical Topics: Acute Coronary Syndromes, Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure
Keywords: Acute Coronary Syndrome, Delivery of Health Care, Integrated, Geriatrics, Heart Failure, Hospital Mortality, Myocardial Infarction, Patient Readmission, Pneumonia, Primary Prevention, Risk
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