title: 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: OBJECTIVE
  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.
  
  
  METHODS
  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).
  
  
  METHODS
  Hospitalization in a VA or non-VA hospital in MSAs that contained at least 1 VA and non-VA hospital.
  
  
  METHODS
  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
  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.
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Sudhakar V
authors: SV
authors: Nuti
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut2Section of Cardiovascular Medicine, the Robert Wood Johnson Foundation Clinical Scholars Program, the Section of General Internal Medicine, and Section of Rheumat.
authors: Li
authors: L
authors: Qin
authors: The VA Eastern Colorado Healthcare System, Denver.
authors: John S
authors: JS
authors: Rumsfeld
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut2Section of Cardiovascular Medicine, the Robert Wood Johnson Foundation Clinical Scholars Program, the Section of General Internal Medicine, and Section of Rheumat.
authors: Joseph S
authors: JS
authors: Ross
authors: Department of Medicine, University of Colorado Anschutz Medical Campus, Aurora.
authors: Frederick A
authors: FA
authors: Masoudi
authors: Department of Health Care Policy, Harvard Medical School, Boston, Massachusetts7Department of Biostatistics, Harvard T.H. Chan School of Public Health, Boston, Massachusetts.
authors: Sharon-Lise T
authors: SL
authors: Normand
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Karthik
authors: K
authors: Murugiah
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut.
authors: Susannah M
authors: SM
authors: Bernheim
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut2Section of Cardiovascular Medicine, the Robert Wood Johnson Foundation Clinical Scholars Program, the Section of General Internal Medicine, and Section of Rheumat.
authors: Lisa G
authors: LG
authors: Suter
authors: Center for Outcomes Research and Evaluation, Yale-New Haven Hospital, New Haven, Connecticut2Section of Cardiovascular Medicine, the Robert Wood Johnson Foundation Clinical Scholars Program, the Section of General Internal Medicine, and Section of Rheumat.
authors: Harlan M
authors: HM
authors: Krumholz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D006333:Heart Failure / Q000401:mortality*; D017052:Hospital Mortality; D006761:Hospitals / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D009203:Myocardial Infarction / Q000401:mortality*; D010359:Patient Readmission; D011014:Pneumonia / Q000401:mortality*; D014481:United States