Do older rural and urban veterans experience different rates of unplanned readmission to VA and non-VA hospitals?
BACKGROUND
Unplanned readmission within 30 days of discharge is an indicator of hospital quality.


OBJECTIVE
We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts.


METHODS
We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004. We calculated 30-day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30-day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity.


RESULTS
Overall, rural veterans had slightly higher 30-day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural- and urban-dwelling veterans, readmission after using a VA hospital was more common than after using a non-VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital.


CONCLUSIONS
Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non-VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non-VA hospitals.
Weeks
William B
WB
Field Office, VA National Center for Patient Safety, White River Junction, VT 05009, USA. wbw@dartmouth.edu
Lee
Richard E
RE
Wallace
Amy E
AE
West
Alan N
AN
Bagian
James P
JP
D000367:Age Factors; D000368:Aged; D019985:Benchmarking; D003953:Diagnosis-Related Groups / Q000145:classification; D005260:Female; D019538:Health Care Surveys; D006764:Hospitals, Community / Q000592:standards / Q000706:statistics & numerical data*; D006787:Hospitals, Veterans / Q000592:standards / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D019984:Quality Indicators, Health Care; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review; D014728:Veterans / Q000145:classification / Q000706:statistics & numerical data*