Among older men with heart attack, heart failure or pneumonia, hospitalisation at Veterans Affairs (VA) hospitals was associated with lower 30-day all-cause mortality rates for heart attack and heart failure and higher 30-day all-cause readmission rates for these conditions as compared with hospitalisations at non-VA hospitals. Any absolute differences between these outcomes are small. The study is published in JAMA.
Since there is very little information available about comparative performance between VA and non-VA hospitals with respect to mortality and readmission rates, researchers included male Medicare fee-for-service beneficiaries age 65 years or older hospitalised between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction, heart failure, or pneumonia, using Medicare and VA data. Each condition-outcome analysis cohort for VA and non-VA hospitals contained at least 7,900 patients, in 92 metropolitan statistical areas (MSAs).
The findings showed that mortality rates were lower in VA hospitals as compared to non-VA hospitals for AMI and HF but higher for pneumonia. Hospital readmission rates were higher in VA hospitals for all 3 conditions as compared to non-VA hospitals. VA hospitals had lower mortality rates for AMI and HF and mortality rates for pneumonia were not significantly different. However, VA hospitals had higher readmission rates for AMI, HF or pneumonia.
While the authors note that the differences in mortality and readmission rates persisted after accounting for geographic variation, but in general the magnitude of differences were small for both measures across all the three conditions.
In an accompanying editorial, Ashish K. Jha, MD, MPH, of the Harvard T. H. Chan School of Public Health, Boston, writes that this study begins to answer the question of whether VA is meeting its obligations to care for veterans by focusing 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?. He says, "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.”
Source: JAMA
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