Lower mortality, higher readmissions rates for common conditions in VA hospitals

1. For acute myocardial infarction and heart failure in male patients older than 65 years, 30-day mortality was lower in Veteran’s Affairs (VA) hospitals than non-VA hospitals. There was no mortality difference between hospitals for pneumonia.

2. Readmission rates for acute myocardial infarction, heart failure, and pneumonia were higher at VA hospitals than non-VA hospitals.

Evidence Rating Level: 3 (Average)

Study Rundown: Although the real and perceived deficiencies of care provided at Veteran’s Affairs (VA) hospitals has been a topic of recent media coverage, there is little data comparing the results of care to other, non-VA hospitals. In the past few years, the VA and Centers for Medicare and Medicaid Services (CMS) have aligned their measurements of health outcomes. Utilizing this newly available comparable data, this study assessed the outcomes for patients at VA and non-VA hospitals with 3 common conditions—acute myocardial infarction (MI), heart failure (HF), and pneumonia. When adjusting for geographical differences, the study found that the 30-day mortality rates were lower at VA hospitals for patients with AMI and HF. The mortality was similar for pneumonia. The readmission rates, however, were higher at VA hospitals for all three conditions. While the mortality differences are small, they may be lower at VA hospitals due to unmeasured bias or the effects of a recent, system-wide cardiac care improvement project. The readmission rates are higher, likely due to the VA’s greater propensity for admission, and the CMS’s current readmission reduction program. While this study was limited to analyzing administrative records for elderly male patients only, it provides a clear comparison of outcomes at VA hospitals and non-VA hospitals, suggesting ways that outcomes could be improved across the 2 systems.

Click to read the study, published today in JAMA

Relevant Reading: Risk-adjusted mortality as an indicator of outcomes: comparison of the Medicare advantage program with the veteran’s health administration

In-Depth [cross-sectional study]: This cross-sectional analysis compared the mortality and readmission rates among male patients older than 65-years of age at VA and non-VA hospitals. It reviewed administration-level data from 104 VA hospitals and 1513 non-VA hospitals each with at least 7900 patients. Comparisons were made between the systems as a whole, and between hospitals in similar geographic regions, controlling for variations in patients and practices. After adjusting for these geographical differences, the study found that the 30-day mortality rates were lower at VA hospitals for patients with AMI (percentage point difference -0.22, C95%CI -0.40 to -0.04) and HF (difference -0.63, 95%CI -0.95 to -0.31). The mortality was similar for pneumonia (difference -0.03, 95%CI -0.46 to 0.40). Readmission rates were higher at VA hospitals for all 3 conditions (AMI difference 0.62, 95%CI 0.48 to 0.75; HF difference 0.97, 95%CI 0.59 to 1.34; pneumonia difference 0.66, 95%CI 0.41 to 0.91).

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