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2011 HSR&D National Meeting Abstract

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2011 National Meeting

3058 — Trends in Readmission Rates within the Veterans Health Administration (VHA)

Loveland SA (COLMR at VA Boston Healthcare System), Shin MH (COLMR at VA Boston Healthcare System), Borzecki AB (CHQOER at Bedford VA Medical Center), Chen Q (COLMR at VA Boston Healthcare System & BU School of Public Health), Zhao S (CHQOER at Bedford VA Medical Center), Hanchate A (COLMR at VA Boston Healthcare System & BU School of Medicine), Rosen AK (COLMR at VA Boston Healthcare System & BU School of Public Health)

Objectives:
Escalating healthcare costs have revived policymakers’ interests in using readmissions as a quality measure. Hospital Compare, developed by the Centers for Medicare and Medicaid Services (CMS), mandates public reporting of 30-day all-cause readmissions for three conditions with relatively high readmission rates: acute myocardial infarction (AMI), heart failure (HF), and pneumonia. Recent studies outside the Veterans Health Administration (VHA), have explored readmission trends for these conditions; however, literature about current VHA readmissions rates is sparse. Therefore, this study aims to: 1) assess the prevalence of these three conditions in the VHA and 2) examine their 30-day readmission rates.

Methods:
The study population consisted of FY2003-FY2007 acute-care hospital discharges from the VHA with a principal diagnosis of AMI, HF, or pneumonia, excluding index discharges ending in death or against medical advice. Hospital-level hierarchical logistic regression models, adjusting for age, gender, and comorbidities, were estimated to predict readmission rates for each cohort.

Results:
Of 1,795,303 hospitalizations, 15.2% of all index discharges resulted in a 30-day readmission to a VHA hospital. The prevalence of AMI, HF, and pneumonia among index discharges was 1.9%, 4.5%, and 4.0%, respectively. AMI had the highest rate of 30-day readmission (21.7%), followed by HF (20.0%), and pneumonia (14.4%). HF patients were more likely to be readmitted within 30 days for the same condition (42.6%) compared to those with pneumonia (22.4%) and AMI (17.2%). Readmission rates for patients in the top decile of risk were higher than those in the bottom decile (22.0% vs. 9.9%, respectively), indicating good model calibration.

Implications:
Readmission rates for AMI, HF, and pneumonia were comparable to Medicare 2005-2008 rates (19.9%, 24.5%, and 18.2%, respectively). While AMI patients had the highest rates of 30-day readmission, HF patients were most likely to be readmitted for the same condition.

Impacts:
VHA, like CMS, could consider adding readmission to its portfolio of quality measures. Although programs to improve the quality of care for these conditions currently exist in VHA (e.g., CHF Quality Enhancement Research Initiative), specific resources should be devoted to prevention of avoidable readmissions. Targeted clinical interventions and improved coordination of care between the inpatient and outpatient settings are critically needed.


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