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Mortality rates among older men in Veterans Affairs hospitals were lower for acute myocardial infarction and heart failure but higher for pneumonia, compared with non–Veterans Affairs hospitals, a study has found.
Researchers conducted a cross-sectional analysis of more than 7,900 male Medicare fee-for-service beneficiaries aged 65 years and older who were hospitalized in 104 VA and 1,513 non-VA acute care hospitals for acute myocardial infarction, heart failure, or pneumonia between 2010 and 2013.
The analysis, published online Feb. 9, showed that, for the VA hospitals, after adjusting for risk, 30-day mortality for acute MI was 0.17 percentage points lower (P = .02) and 30-day heart failure mortality was 0.44 percentage points lower (P = .008), compared with non-VA hospitals (JAMA. 2016;315[6]:582-92. doi: 10.1001/jama.2016.0278).
The differences between VA and non-VA hospitals were even greater when the comparison was made between hospitals in the same metropolitan statistical area: differences of 0.22 percentage points for 30-day mortality for acute MI (P = .02) and 0.63 percentage points for heart failure (P < .001).
“The finding that risk standardized mortality rates for cardiovascular conditions were lower, albeit with small absolute differences, in VA hospitals may reflect higher quality of care in VA hospitals as represented by adherence to process measures,” wrote Sudhakar V. Nuti of the Center for Outcomes Research and Evaluation at Yale-New Haven (Conn.) Hospital and coauthors.
“The lower mortality rates also may be due to the quality improvement efforts that can be implemented across the VA’s integrated delivery system,” they added.
Mortality rates for pneumonia were 0.46 percentage points higher in VA hospitals, compared with non-VA hospitals (P = .045). But after comparing hospitals within the same metropolitan area, this difference disappeared.
VA hospitals also had higher readmission rates than non-VA hospitals for all three conditions: 0.63 percentage points higher for acute MI, 1.2 points higher for heart failure, and 0.76 points higher for pneumonia (P < .001 for all).
This difference persisted when hospitals within the same area were compared.
Commenting on the readmission differences, the investigators suggested that VA hospitals may have a greater propensity to readmit patients, or that veterans may have to travel further to VA hospitals – which has been associated with higher readmission rates among veterans. They also pointed out, however, that non-VA hospitals had recently been subject to national interventions to reduce readmissions.
The study also showed that VA hospitals were more likely to be teaching hospitals and were larger and had a greater number of beds than non-VA hospitals. Around 12% of individuals who were initially hospitalized at VA hospitals were readmitted to non-VA hospitals, but less than 1% of individuals admitted to a non-VA hospital initially were later readmitted to a VA hospital, irrespective of their condition.
“The current study serves as an example of national performance comparison for VA and non-VA hospital care, which sets the stage for future performance and quality improvement studies,” the authors reported.
“Moreover, the results of our study and other benchmarking efforts could inform efforts to improve quality in the VA, particularly our findings of variation in performance, by identifying and learning from high performing hospitals and disseminating best practices to lower performing hospitals to elevate the entire performance curve.”
The authors stressed that, since the study population was limited to men over age 65 years who were VA or Medicare patients, the results were not generalizable to younger or female populations.
Some of the study’s authors were supported by grants from the National Institute on Aging; the American Federation for Aging Research; the National Heart, Lung, and Blood Institute; and the VA Connecticut Healthcare System. Two authors declared research agreements from Medtronic and Johnson & Johnson, one declared positions on a cardiac scientific advisory board for UnitedHealth, and four declared contract work for the Centers for Medicare & Medicaid Services. No other conflicts of interest were declared.
“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.
“That the VA, an integrated delivery system with a well-functioning information technology infrastructure, has higher readmission rates than non-VA hospitals, which are largely stand-alone entities with a high degree of fragmentation and little information sharing, is important. It is yet more evidence that readmissions primarily measure how sick and poor the patient population is, not how good or how integrated the care is.”
Dr. Ashish K. Jha is with the department of health policy and management at the Harvard T. H. Chan School of Public Health, Boston. These comments are from an accompanying editorial (JAMA. 2016 Feb 9. doi: 10.1001/jama.2016.0243). Dr. Jha disclosed that he is an attending physician at the Boston VA Healthcare System and declared an earlier role as special adviser to former VA Secretary Eric Shinseki through 2012.
“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.
“That the VA, an integrated delivery system with a well-functioning information technology infrastructure, has higher readmission rates than non-VA hospitals, which are largely stand-alone entities with a high degree of fragmentation and little information sharing, is important. It is yet more evidence that readmissions primarily measure how sick and poor the patient population is, not how good or how integrated the care is.”
Dr. Ashish K. Jha is with the department of health policy and management at the Harvard T. H. Chan School of Public Health, Boston. These comments are from an accompanying editorial (JAMA. 2016 Feb 9. doi: 10.1001/jama.2016.0243). Dr. Jha disclosed that he is an attending physician at the Boston VA Healthcare System and declared an earlier role as special adviser to former VA Secretary Eric Shinseki through 2012.
“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.
“That the VA, an integrated delivery system with a well-functioning information technology infrastructure, has higher readmission rates than non-VA hospitals, which are largely stand-alone entities with a high degree of fragmentation and little information sharing, is important. It is yet more evidence that readmissions primarily measure how sick and poor the patient population is, not how good or how integrated the care is.”
Dr. Ashish K. Jha is with the department of health policy and management at the Harvard T. H. Chan School of Public Health, Boston. These comments are from an accompanying editorial (JAMA. 2016 Feb 9. doi: 10.1001/jama.2016.0243). Dr. Jha disclosed that he is an attending physician at the Boston VA Healthcare System and declared an earlier role as special adviser to former VA Secretary Eric Shinseki through 2012.
Mortality rates among older men in Veterans Affairs hospitals were lower for acute myocardial infarction and heart failure but higher for pneumonia, compared with non–Veterans Affairs hospitals, a study has found.
Researchers conducted a cross-sectional analysis of more than 7,900 male Medicare fee-for-service beneficiaries aged 65 years and older who were hospitalized in 104 VA and 1,513 non-VA acute care hospitals for acute myocardial infarction, heart failure, or pneumonia between 2010 and 2013.
The analysis, published online Feb. 9, showed that, for the VA hospitals, after adjusting for risk, 30-day mortality for acute MI was 0.17 percentage points lower (P = .02) and 30-day heart failure mortality was 0.44 percentage points lower (P = .008), compared with non-VA hospitals (JAMA. 2016;315[6]:582-92. doi: 10.1001/jama.2016.0278).
The differences between VA and non-VA hospitals were even greater when the comparison was made between hospitals in the same metropolitan statistical area: differences of 0.22 percentage points for 30-day mortality for acute MI (P = .02) and 0.63 percentage points for heart failure (P < .001).
“The finding that risk standardized mortality rates for cardiovascular conditions were lower, albeit with small absolute differences, in VA hospitals may reflect higher quality of care in VA hospitals as represented by adherence to process measures,” wrote Sudhakar V. Nuti of the Center for Outcomes Research and Evaluation at Yale-New Haven (Conn.) Hospital and coauthors.
“The lower mortality rates also may be due to the quality improvement efforts that can be implemented across the VA’s integrated delivery system,” they added.
Mortality rates for pneumonia were 0.46 percentage points higher in VA hospitals, compared with non-VA hospitals (P = .045). But after comparing hospitals within the same metropolitan area, this difference disappeared.
VA hospitals also had higher readmission rates than non-VA hospitals for all three conditions: 0.63 percentage points higher for acute MI, 1.2 points higher for heart failure, and 0.76 points higher for pneumonia (P < .001 for all).
This difference persisted when hospitals within the same area were compared.
Commenting on the readmission differences, the investigators suggested that VA hospitals may have a greater propensity to readmit patients, or that veterans may have to travel further to VA hospitals – which has been associated with higher readmission rates among veterans. They also pointed out, however, that non-VA hospitals had recently been subject to national interventions to reduce readmissions.
The study also showed that VA hospitals were more likely to be teaching hospitals and were larger and had a greater number of beds than non-VA hospitals. Around 12% of individuals who were initially hospitalized at VA hospitals were readmitted to non-VA hospitals, but less than 1% of individuals admitted to a non-VA hospital initially were later readmitted to a VA hospital, irrespective of their condition.
“The current study serves as an example of national performance comparison for VA and non-VA hospital care, which sets the stage for future performance and quality improvement studies,” the authors reported.
“Moreover, the results of our study and other benchmarking efforts could inform efforts to improve quality in the VA, particularly our findings of variation in performance, by identifying and learning from high performing hospitals and disseminating best practices to lower performing hospitals to elevate the entire performance curve.”
The authors stressed that, since the study population was limited to men over age 65 years who were VA or Medicare patients, the results were not generalizable to younger or female populations.
Some of the study’s authors were supported by grants from the National Institute on Aging; the American Federation for Aging Research; the National Heart, Lung, and Blood Institute; and the VA Connecticut Healthcare System. Two authors declared research agreements from Medtronic and Johnson & Johnson, one declared positions on a cardiac scientific advisory board for UnitedHealth, and four declared contract work for the Centers for Medicare & Medicaid Services. No other conflicts of interest were declared.
Mortality rates among older men in Veterans Affairs hospitals were lower for acute myocardial infarction and heart failure but higher for pneumonia, compared with non–Veterans Affairs hospitals, a study has found.
Researchers conducted a cross-sectional analysis of more than 7,900 male Medicare fee-for-service beneficiaries aged 65 years and older who were hospitalized in 104 VA and 1,513 non-VA acute care hospitals for acute myocardial infarction, heart failure, or pneumonia between 2010 and 2013.
The analysis, published online Feb. 9, showed that, for the VA hospitals, after adjusting for risk, 30-day mortality for acute MI was 0.17 percentage points lower (P = .02) and 30-day heart failure mortality was 0.44 percentage points lower (P = .008), compared with non-VA hospitals (JAMA. 2016;315[6]:582-92. doi: 10.1001/jama.2016.0278).
The differences between VA and non-VA hospitals were even greater when the comparison was made between hospitals in the same metropolitan statistical area: differences of 0.22 percentage points for 30-day mortality for acute MI (P = .02) and 0.63 percentage points for heart failure (P < .001).
“The finding that risk standardized mortality rates for cardiovascular conditions were lower, albeit with small absolute differences, in VA hospitals may reflect higher quality of care in VA hospitals as represented by adherence to process measures,” wrote Sudhakar V. Nuti of the Center for Outcomes Research and Evaluation at Yale-New Haven (Conn.) Hospital and coauthors.
“The lower mortality rates also may be due to the quality improvement efforts that can be implemented across the VA’s integrated delivery system,” they added.
Mortality rates for pneumonia were 0.46 percentage points higher in VA hospitals, compared with non-VA hospitals (P = .045). But after comparing hospitals within the same metropolitan area, this difference disappeared.
VA hospitals also had higher readmission rates than non-VA hospitals for all three conditions: 0.63 percentage points higher for acute MI, 1.2 points higher for heart failure, and 0.76 points higher for pneumonia (P < .001 for all).
This difference persisted when hospitals within the same area were compared.
Commenting on the readmission differences, the investigators suggested that VA hospitals may have a greater propensity to readmit patients, or that veterans may have to travel further to VA hospitals – which has been associated with higher readmission rates among veterans. They also pointed out, however, that non-VA hospitals had recently been subject to national interventions to reduce readmissions.
The study also showed that VA hospitals were more likely to be teaching hospitals and were larger and had a greater number of beds than non-VA hospitals. Around 12% of individuals who were initially hospitalized at VA hospitals were readmitted to non-VA hospitals, but less than 1% of individuals admitted to a non-VA hospital initially were later readmitted to a VA hospital, irrespective of their condition.
“The current study serves as an example of national performance comparison for VA and non-VA hospital care, which sets the stage for future performance and quality improvement studies,” the authors reported.
“Moreover, the results of our study and other benchmarking efforts could inform efforts to improve quality in the VA, particularly our findings of variation in performance, by identifying and learning from high performing hospitals and disseminating best practices to lower performing hospitals to elevate the entire performance curve.”
The authors stressed that, since the study population was limited to men over age 65 years who were VA or Medicare patients, the results were not generalizable to younger or female populations.
Some of the study’s authors were supported by grants from the National Institute on Aging; the American Federation for Aging Research; the National Heart, Lung, and Blood Institute; and the VA Connecticut Healthcare System. Two authors declared research agreements from Medtronic and Johnson & Johnson, one declared positions on a cardiac scientific advisory board for UnitedHealth, and four declared contract work for the Centers for Medicare & Medicaid Services. No other conflicts of interest were declared.
FROM JAMA
Key clinical point: Veterans Affairs hospitals have slightly lower mortality rates for cardiovascular conditions but slightly higher readmission rates.
Major finding: VA hospitals had a 0.17 percentage point lower 30-day mortality for acute MI and 0.44 percentage point lower mortality for heart failure, compared with non-VA hospitals.
Data source: A cross-sectional analysis of more than 7,900 male Medicare fee-for-service beneficiaries hospitalized in 105 VA and 1,513 non-VA acute care hospitals.
Disclosures: Some of the study’s authors were supported by grants from the National Institute on Aging; the American Federation for Aging Research; the National Heart, Lung, and Blood Institute; and the VA Connecticut Healthcare System. Two authors declared research agreements from Medtronic and Johnson & Johnson, one declared positions on a cardiac scientific advisory board for UnitedHealth, and four declared contract work for the Centers for Medicare & Medicaid Services. No other conflicts of interest were declared.
