Admission to VA Hospital Associated with Different Mortality, Readmission Rates for AMI, HF, Pneumonia

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Differences in mortality and readmission rates persist even after accounting for geographic variation in hospital location.
Differences in mortality and readmission rates persist even after accounting for geographic variation in hospital location.

HealthDay News - For older men, mortality and readmission for acute myocardial infarction (AMI), heart failure (HF), and pneumonia vary with admission to Veterans Affairs (VA) and non-VA hospitals, according to a study published in the Feb. 9 issue of the Journal of the American Medical Association.1

Sudhakar V. Nuti, from the Yale-New Haven Hospital in Connecticut, and colleagues examined and compared mortality and readmission rates among men in VA and non-VA hospitals. Data were included for male Medicare fee-for-service beneficiaries aged 65 years or older and hospitalized between 2000 and 2013 for AMI, heart failure, and pneumonia. The authors compared 30-day risk-standardized mortality rates and readmission rates for 104 VA and 1,513 non-VA hospitals.

The researchers found that, compared with non-VA hospitals, in VA hospitals mortality rates were lower for AMI (13.5 versus 13.7; P = 0.02) and heart failure (11.4 versus 11.9%; P = 0.008), but not for pneumonia (12.6 versus 12.2%; P = 0.45). For all three conditions, readmission rates were higher at VA hospitals: AMI, 17.8 versus 17.2%; heart failure, 24.7 versus 23.5%; and pneumonia, 19.4 versus 18.7% (all P < 0.001).

"Among older men with AMI, heart failure, or pneumonia, hospitalization at VA hospitals, compared with hospitalization at non-VA hospitals, was associated with lower 30-day risk-standardized all-cause mortality rates for AMI and heart failure, and higher 30-day risk-standardized all-cause readmission rates for all three conditions," the authors write.

Several authors disclosed financial ties to the pharmaceutical, medical device, and health care industries.

Summary and Clinical Applicability

Ashish K. Jha, MD, MPH, of the Harvard School of Public Health, Boston, wrote in an accompanying editorial that the study begins to answer the question of whether the VA is meeting its obligations to adequately care for veterans.2

"The authors focus on a narrow set of questions: how does the VA compare with the rest of the health care system on care for a common set of medical conditions? The findings are reassuring and make plain that even though the VA has much work to do, it is starting off from a substantially better place than it was in 2 decades ago."

"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."

Reference

1. Nuti SV, Qin L, Rumsfeld JS, et al. Association of Admission to Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia. JAMA. 2016;315(6):582-592. doi:10.1001/jama.2016.0278.

2. Ashish K. Jha. Learning From the Past to Improve VA Health Care.JAMA, February 2016 DOI: 10.1001/jama.2016.0243


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Nuti SV, Qin L, Rumsfeld JS, et al. Association of Admission to Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia. JAMA. 2016;315(6):582-592. doi:10.1001/jama.2016.0278.
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