title: Impact of the Hospital to Home Initiative on Readmissions in the VA Health Care System.
abstract: Hospital to Home (H2H) is a national quality improvement initiative sponsored by the Institute for Healthcare Improvement and the American College of Cardiology, with the goal of reducing readmission for patients hospitalized with heart disease. We sought to determine the impact of H2H within the Veterans Affairs (VA) health care system.
  
  
  
  Using a controlled interrupted time series, we determined the association of VA hospital enrollment in H2H with the primary outcome of 30-day all-cause readmission following a heart failure hospitalization. VA heart failure providers were surveyed to determine quality improvement projects initiated in response to H2H. Secondary outcomes included initiation of recommended H2H projects, follow-up within 7 days, and total hospital days at 30 days and 1 year.
  
  
  
  Sixty-five of 104 VA hospitals (66%) enrolled in the national H2H initiative. Hospital characteristic associated with H2H enrollment included provision of tertiary care, academic affiliation, and greater use of home monitoring. There was no significant difference in mean 30-day readmission rates (20.0% ± 5.0% for H2H vs 19.3% ± 5.9% for non-H2H hospitals; P = .48) The mean fraction of patients with a cardiology visit within 7 days was slightly higher for H2H hospitals (3.0% ± 2.4% for H2H vs 2.0% ± 1.9% for non-H2H hospitals; P = .05). Patients discharged from H2H hospitals had fewer mean hospitals days during the following year (7.6% ± 2.6% for H2H vs 9.2% ± 3.0 for non-H2H; P = .01) early after launch of H2H, but the effect did not persist.
  
  
  
  VA hospitals enrolling in H2H had slightly more early follow-up in cardiology clinic but no difference in 30-day readmission rates compared with hospitals not enrolling in H2H.
authors.affiliation: Veterans Administration Palo Alto Health Care System, Palo Alto, California (Drs Heidenreich, Sahay, and Oliva and Mss Gholami and Lin); Greater Los Angeles VA Health Care System, Los Angeles, California (Dr Mittman); and Eastern Colorado VA Health Care System, Denver, Colorado (Dr Rumsfeld).
authors.forename: Paul A
authors.initials: PA
authors.lastname: Heidenreich
authors.forename: Anju
authors.initials: A
authors.lastname: Sahay
authors.forename: Nancy
authors.initials: N
authors.lastname: Oliva
authors.forename: Parisa
authors.initials: P
authors.lastname: Gholami
authors.forename: Shoutzu
authors.initials: S
authors.lastname: Lin
authors.forename: Brian S
authors.initials: BS
authors.lastname: Mittman
authors.forename: John S
authors.initials: JS
authors.lastname: Rumsfeld
mesh_terms: D003266:Continuity of Patient Care / Q000706:statistics & numerical data*; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000652:urine*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D018670:Monitoring, Ambulatory; D010351:Patient Discharge / Q000706:statistics & numerical data*; D010359:Patient Readmission / Q000706:statistics & numerical data*; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*