Risk of Hospital Readmissions and Association With Receipt of Post-Hospitalization Care Coordination Services Among High-Risk Veterans.

Govier DJ, Niederhausen M, Hickok A, Rowneki M, McCready H, Moss A, Cordasco KM, McDonald KM, Maciejewski ML, Thomas KC, Hynes DM. Risk of Hospital Readmissions and Association With Receipt of Post-Hospitalization Care Coordination Services Among High-Risk Veterans. Health services research. 2025 Sep 26; e70044, DOI: 10.1111/1475-6773.70044.

Related HSR&D Project(s)

• RCS 10-391 – Research Career Scientist
• IIR 20-165 – Care Coordination and Outcomes for High Risk Patients: Building the Evidence for Implementation

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Abstract:

OBJECTIVE: To examine associations between receipt of post-hospitalization care coordination and VA-delivered, VA-purchased, and Medicare fee-for-service hospital readmissions among Veterans at high risk for hospitalization and/or mortality. STUDY SETTING AND DESIGN: In this observational retrospective cohort study, we compared high-risk Veterans who received care coordination within one day after hospital discharge ("treated") with up to five matched high-risk Veterans who did not receive care coordination during this time ("comparators"). Competing risk models estimated adjusted sub-hazard ratios (aSHR) for 30-day all-cause and ambulatory care sensitive condition (ACSC) readmissions between treated and comparators, with death as a competing risk. In sensitivity analyses, we implemented inverse probability of censoring weights to account for censoring due to cross-over to treatment among comparators during follow-up. DATA SOURCES AND ANALYTIC SAMPLE: Data sources included the VA Vital Status File, VA Corporate Data Warehouse, and Centers for Medicare and Medicaid Services administrative files. Participants included 31,614 treated and 99,634 comparator high-risk Veterans initially hospitalized in fiscal year 2021. PRINCIPAL FINDINGS: Participants were primarily male sex, = 65?years of age, and had initial hospitalizations in VA facilities; 15.9% and 2.3% of treated Veterans had 30-day all-cause and ACSC readmissions, respectively, compared with 13.5% and 2.1% of comparators. After accounting for the competing risk of death and covariates that remained imbalanced across groups after matching, post-hospitalization care coordination was associated with no difference in the risk of 30-day all-cause (aSHR 1.03, 95% CI 1.00, 1.07) and ACSC (aSHR 0.97, 95% CI 0.89, 1.05) readmission among high-risk Veterans. The risk of ACSC readmission was similar after including censoring weights (aSHR 1.00, 95% CI 0.92, 1.09); the increased risk of all-cause readmission was small in magnitude but statistically significant (aSHR 1.09, 95% CI 1.05, 1.13). CONCLUSIONS: Receipt of post-hospitalization care coordination was largely associated with no difference in 30-day readmission risk, suggesting that alternative or additional services may be needed to address readmissions among high-risk Veterans.