Impact of Non-VHA Readmissions on VHA Hospital Performance
Author Information
Author(s): Vaughan Sarrazin Mary PhD, Gao Yubo PhD, Jacobs Carly A. MPH, Jacobs Michael A. MS, Schmidt Susanne PhD, Davila Heather PhD MPA, Hadlandsmyth Katherine PhD, Strayer Andrea L. PhD ARNP CNRN, Cashy John PhD, Wehby George PhD, Shireman Paula K. MD MBA MS, Hall Daniel E. MD MDiv MHSc
Primary Institution: Center for Access and Delivery Research and Evaluation, Iowa City Veterans Affairs Medical Center
Hypothesis
Including non-VHA readmissions alters hospital RSRR rankings and readmission metrics improve for VHA hospitals with better continuity of care when non-VHA readmissions are included.
Conclusion
Not accounting for readmissions occurring in non-VHA hospitals may distort hospital performance metrics to the detriment of VHA hospitals with better continuity of care and higher patient volumes and surgical complexity.
Supporting Evidence
- Nearly half (45%) of VHA hospitals changed performance rank when non-VHA readmissions were included.
- VHA hospitals with higher volume and complexity had lower rates of non-VHA readmissions.
- The combined readmission rate was 14.0%.
Takeaway
This study found that many veterans are readmitted to hospitals outside the Veterans Health Administration, and this can change how we measure hospital performance.
Methodology
This retrospective cohort study analyzed data from veterans aged 65 and older who underwent surgery at VHA hospitals from 2013 to 2019, comparing readmissions to VHA and non-VHA hospitals.
Potential Biases
Potential bias in performance metrics due to excluding non-VHA readmissions.
Limitations
The study did not attempt to duplicate current VHA metrics and focused only on patients aged 65 years and older.
Participant Demographics
Mean age of participants was 72.2 years, with 97.6% being male.
Statistical Information
P-Value
P<0.001
Confidence Interval
95% CI, −11.33 to 03.64
Statistical Significance
p<0.05
Digital Object Identifier (DOI)
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