Study Examines Outcomes at VA Hospitals

Older men hospitalized at a Veterans Affairs (VA) hospital for acute myocardial infarction (AMI), heart failure (HF) or pneumonia experienced lower 30-day risk-standardized all-cause mortality rates for AMI and HF, but higher 30-day risk-standardized all-cause readmission rates for all three conditions than those treated at non-VA hospitals, according to a study published Feb. 9 in the Journal of the American Medical Association.

The analysis, by Harlan M. Krumholz, MD, SM, FACC, et al., included male Medicare fee-for-service beneficiaries age 65 years or older hospitalized between 2010 and 2013 in VA (n = 104) and non-VA (n = 1,513) hospitals.

Results showed that mortality rates were lower in VA hospitals than non-VA hospitals for AMI and HF, but higher for pneumonia. Additionally, hospital readmission rates were higher in VA hospitals for all three conditions. These rates were highly statistically significant, but had generally less than 1 percent absolute risk difference. The authors note that these differences in mortality and readmission rates persisted after accounting for geographic variation in hospital location by limiting comparisons of VA and non-VA hospitals to those within the same metropolitan statistical area.

In an accompanying editorial comment, Ashish K. Jha, MD, MPH, writes that "These findings are important because they suggest that despite all of the challenges that VA hospitals have faced, they are still able to deliver high-quality care for some of the sickest, most complicated patients. In addition, although there are large variations in outcomes among VA hospitals, on average, the system seems to be performing reasonably well."

Keywords: Fee-for-Service Plans, Heart Failure, Hospitals, Male, Medicare, Myocardial Infarction, Patient Readmission, Pneumonia, Veterans, Cardiology Magazine

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