Effect of post-discharge follow-up care on re-admissions among US veterans with congestive heart failure: a rural-urban comparison.
BACKGROUND
Hospital re-admissions for patients with congestive heart failure (CHF) are relatively common and costly occurrences within the US health infrastructure, including the Veterans Affairs (VA) healthcare system. Little is known about CHF re-admissions among rural veteran patients, including the effects of socio-demographics and follow-up outpatient visits on these re-admissions.


OBJECTIVE
To examine socio-demographics of US veterans with CHF who had 30 day potentially preventable re-admissions and compare the effect of 30 day VA post-discharge service use on these re-admissions for rural- and urban-dwelling veterans.


METHODS
The 2005-2007 VA data were analyzed to examine patient characteristics and hospital admissions for 36 566 veterans with CHF. The CHF patients who were and were not re-admitted to a VA hospital within 30 days of discharge were identified. Logistic regression was used to examine and compare the effect of VA post-acute service use on re-admissions between rural- and urban-dwelling veterans.


RESULTS
Re-admitted veterans tended to be older (p=.002), had disability status (p=.024) and had longer hospital stays (p<.001). Veterans Affairs follow-up visits were negatively associated with re-admissions for both rural and urban veterans with CHF (ORs 0.16-0.76). Rural veterans aged 65 years and older who had VA emergency room visits following discharge were at high risk for re-admission (OR=2.66).


CONCLUSIONS
Post-acute follow-up care is an important factor for promoting recovery and good health among hospitalized veterans with CHF, regardless of their rural or urban residence. Older, rural veterans with CHF are in need of special attention for VA discharge planning and follow up with primary care providers.
University of North Dakota Center for Rural Health, Grand Forks, USA. klmuus@medicine.nodak.edu
Kyle J
KJ
Muus
Alana
A
Knudson
Marilyn G
MG
Klug
Jane
J
Gokun
Mary
M
Sarrazin
Peter
P
Kaboli
D000367:Age Factors; D000368:Aged; D005500:Follow-Up Studies; D006333:Heart Failure / Q000453:epidemiology* / Q000628:therapy; D006787:Hospitals, Veterans / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D010359:Patient Readmission / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D012307:Risk Factors; D012424:Rural Population / Q000706:statistics & numerical data*; D014481:United States / Q000453:epidemiology; D014505:Urban Population / Q000706:statistics & numerical data*; D014600:Utilization Review; D014728:Veterans / Q000706:statistics & numerical data*