Government and Regulations

VA Facilities Compare Favorably in Large-Scale Comparative Study

Examining 3 disease states, JAMA study finds few differences in patient mortality and readmission rates between VA and non-VA hospitals.


 

A study that compared mortality and readmission rates at VA and non-VA hospitals found little differences in older male patients with acute myocardial infarction (AMI), heart failure (HF), or pneumonia. The JAMA study examined records for 104 VA and 1,513 non-VA hospitals between 2010 and 2013 and compared patient populations in the same metropolitan statistical areas (MSAs).

The finding are “reassuring” according to Ashish Jha, MD, MPH, in an accompanying editorial, noting that “even though the VA has much work to do, it is starting off from a substantially better place than it was 2 decades ago.”

Among men aged ≥ 65 years with AMI, HF, or pneumonia, hospitalization at VA hospitals was associated with “lower 30-day risk-standardized all-cause mortality rates for AMI and HF.” However, as the authors report, the 30-day, risk-standardized all-cause readmission rate for patients with all 3 conditions was higher. These trends were seen both nationally and within similar geographic areas. The authors cautioned that the “absolute differences between these outcomes at VA and non-VA hospitals were small.”

Mortality rates were lower at VA hospitals for patients with AMI and HF (13.5% and 11.4%, respectively) than those for non-VA hospitals (13.7% and 11.9%, respectively). Readmission rates were reversed for pneumonia with the VA facilities lagging behind (12.6% vs 12.2%). However, the VA also lagged behind in readmission rates for AMI (17.8% vs 17.2%), HF (24.7% vs 23.5%), and pneumonia (19.4% vs 18.7%).

Success is significant with respect to mortality rates for the VA. As Jha suggests, readmission rates largely reflect “how sick and poor the patient population is, not how good or how integrated the care is.” Still the research examined only a small cross-section of VA health care, which suggests the need for more research comparing VA and non-VA facilities

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