Study Shows Decreases in VA Hospital Length-of-Stay and Readmission Rates over 14 Years
Improving hospital efficiency by reducing the length of a patient's stay should benefit both patients and hospitals. However, there is emerging concern that excessive reductions in length of stay (LOS) may be harmful because discharge before patients are medically stable can result in hospital readmission or use of emergency department services. Readmission within 30 days for medical conditions is common and costly. In studies of Medicare patients, 30-day readmission rates range from 8% to 21%, depending on diagnosis, with annual estimated costs of more than $17 billion. This observational study sought to determine trends in hospital length of stay and 30-day readmission rates in the VA healthcare system for all medical diagnoses combined, including five common diagnoses that were also examined separately: heart failure, chronic obstructive pulmonary disease (COPD), acute myocardial infarction (AMI), community-acquired pneumonia, and gastrointestinal hemorrhage. Using VA data, investigators identified all acute medical admissions to 129 VA hospitals from FY97 to FY10, with the final cohort totaling more than 4 million admissions over 14 years. Readmissions were examined if they occurred within 30 days of the date of discharge from the index admission — and were linked to the relevant index admission. Hospital LOS was defined as the number of days from patient admission until discharge. A secondary outcome was death occurring within 30 or 90 days of admission, either in the hospital or after discharge.
- VA hospitals demonstrated simultaneous improvements in hospital LOS and readmission rates from 1997 to 2010. This demonstrates that LOS reductions have not, thus far, adversely affected the likelihood of hospital readmission.
- For all medical diagnoses combined, the risk-adjusted mean hospital LOS decreased by 1.5 days — from 5.4 to 4.0, or 2% annually. Reductions in LOS also were observed for the five specific common diagnoses, with the greatest reductions for AMI (2.9 days) and pneumonia (2.2 days).
- Risk-adjusted 30-day readmission rates for all medical diagnoses combined decreased from 17% to 14%. Reductions also were observed for the five common diagnoses, with greatest reductions for AMI (23% to 20%) and COPD (18% to 15%).
- All-cause mortality 90 days after admission was reduced by 3% annually.
- Authors note that hospitals with mean risk-adjusted LOS that was lower than expected had a higher readmission rate (6% increase for each day lower than expected), suggesting a modest tradeoff.
- Readmissions to non-VA hospitals were not identified.
- Administrative claims data were used that do not include important prognostic and clinical indicators.
- Investigators did not distinguish between preventable hospital readmissions and all other readmissions.
Kaboli P, Go J, Hockenberry J, Glasgow J, Johnson S, Rosenthal G, Jones M, and Vaughan-Sarrazin M. Associations between Reduced Hospital Length of Stay and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals. Annals of Internal Medicine December 18, 2012;157(12):837-845.