Association of Admission to Veterans Affairs Hospitals vs Non-Veterans Affairs Hospitals With Mortality and Readmission Rates Among Older Men Hospitalized With Acute Myocardial Infarction, Heart Failure, or Pneumonia

Abstract

Importance: Little contemporary information is available about comparative performance between Veterans Affairs (VA) and non-VA hospitals, particularly related to mortality and readmission rates, 2 important outcomes of care.

Objective: To assess and compare mortality and readmission rates among men in VA and non-VA hospitals.

Design, setting, and participants: Cross-sectional analysis involving male Medicare fee-for-service beneficiaries aged 65 years or older hospitalized between 2010 and 2013 in VA and non-VA acute care hospitals for acute myocardial infarction (AMI), heart failure (HF), or pneumonia using the Medicare Standard Analytic Files and Enrollment Database together with VA administrative claims data. To avoid confounding geographic effects with health care system effects, we studied VA and non-VA hospitals within the same metropolitan statistical area (MSA).

Exposures: Hospitalization in a VA or non-VA hospital in MSAs that contained at least 1 VA and non-VA hospital.

Main outcomes and measures: For each condition, 30-day risk-standardized mortality rates and risk-standardized readmission rates for VA and non-VA hospitals. Mean aggregated within-MSA differences in mortality and readmission rates were also assessed.

Results: We studied 104 VA and 1513 non-VA hospitals, with each condition-outcome analysis cohort for VA and non-VA hospitals containing at least 7900 patients (men; ≥65 years), in 92 MSAs. Mortality rates were lower in VA hospitals than non-VA hospitals for AMI (13.5% vs 13.7%, P = .02; -0.2 percentage-point difference) and HF (11.4% vs 11.9%, P = .008; -0.5 percentage-point difference), but higher for pneumonia (12.6% vs 12.2%, P = .045; 0.4 percentage-point difference). In contrast, readmission rates were higher in VA hospitals for all 3 conditions (AMI, 17.8% vs 17.2%, 0.6 percentage-point difference; HF, 24.7% vs 23.5%, 1.2 percentage-point difference; pneumonia, 19.4% vs 18.7%, 0.7 percentage-point difference, all P < .001). In within-MSA comparisons, VA hospitals had lower mortality rates for AMI (percentage-point difference, -0.22; 95% CI, -0.40 to -0.04) and HF (-0.63; 95% CI, -0.95 to -0.31), and mortality rates for pneumonia were not significantly different (-0.03; 95% CI, -0.46 to 0.40); however, VA hospitals had higher readmission rates for AMI (0.62; 95% CI, 0.48 to 0.75), HF (0.97; 95% CI, 0.59 to 1.34), or pneumonia (0.66; 95% CI, 0.41 to 0.91).

Conclusions and relevance: Among older men with AMI, HF, or pneumonia, hospitalization at VA hospitals, compared with hospitalization at non-VA hospitals, was associated with lower 30-day risk-standardized all-cause mortality rates for AMI and HF, and higher 30-day risk-standardized all-cause readmission rates for all 3 conditions, both nationally and within similar geographic areas, although absolute differences between these outcomes at VA and non-VA hospitals were small.

Figure 1

Histogram Comparing Risk-Standardized Mortality Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia between Veterans Affairs and non-Veterans Affairs Hospitals, 2010–2013. AMI: acute myocardial infarction, HF: heart failure, PNE: pneumonia. Blue bars and dashed lines indicate VA hospitals, and red bars and dashed lines indicate non-VA hospitals. Bars with purple coloring indicate the overlap of VA and non-VA hospitals.

Figure 1

Histogram Comparing Risk-Standardized Mortality Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia between Veterans Affairs and non-Veterans Affairs Hospitals, 2010–2013. AMI: acute myocardial infarction, HF: heart failure, PNE: pneumonia. Blue bars and dashed lines indicate VA hospitals, and red bars and dashed lines indicate non-VA hospitals. Bars with purple coloring indicate the overlap of VA and non-VA hospitals.

Figure 1

Histogram Comparing Risk-Standardized Mortality Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia between Veterans Affairs and non-Veterans Affairs Hospitals, 2010–2013. AMI: acute myocardial infarction, HF: heart failure, PNE: pneumonia. Blue bars and dashed lines indicate VA hospitals, and red bars and dashed lines indicate non-VA hospitals. Bars with purple coloring indicate the overlap of VA and non-VA hospitals.

Figure 2

Histogram Comparing Risk-Standardized Readmission Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia between Veterans Affairs and non-Veterans Affairs Hospitals, 2010–2013. AMI: acute myocardial infarction, HF: heart failure, PNE: pneumonia. Blue bars and dashed lines indicate VA hospitals, and red bars and dashed lines indicate non-VA hospitals. Bars with purple coloring indicate the overlap of VA and non-VA hospitals.

Figure 2

Histogram Comparing Risk-Standardized Readmission Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia between Veterans Affairs and non-Veterans Affairs Hospitals, 2010–2013. AMI: acute myocardial infarction, HF: heart failure, PNE: pneumonia. Blue bars and dashed lines indicate VA hospitals, and red bars and dashed lines indicate non-VA hospitals. Bars with purple coloring indicate the overlap of VA and non-VA hospitals.

Figure 2

Histogram Comparing Risk-Standardized Readmission Rates for Acute Myocardial Infarction, Heart Failure, and Pneumonia between Veterans Affairs and non-Veterans Affairs Hospitals, 2010–2013. AMI: acute myocardial infarction, HF: heart failure, PNE: pneumonia. Blue bars and dashed lines indicate VA hospitals, and red bars and dashed lines indicate non-VA hospitals. Bars with purple coloring indicate the overlap of VA and non-VA hospitals.