VA Hospitals: How Well Do They Treat Acute Myocardial Infarction, Heart Failure, and Pneumonia?

Summary and Comment |
March 1, 2016

VA Hospitals: How Well Do They Treat Acute Myocardial Infarction, Heart Failure, and Pneumonia?

  1. Joel M. Gore, MD

Care for these three conditions is comparable in urban VA and non-VA hospitals for men ages 65 and older.

  1. Joel M. Gore, MD

Questions about the quality of care in Veterans Affairs (VA) hospitals have been in the headlines recently. These researchers performed a cross-sectional analysis of mortality and readmission rates in men aged ≥65 with acute myocardial infarction (AMI), heart failure (HF), or pneumonia in 104 VA and 1513 non-VA acute-care, urban hospitals.

The analyses used Medicare combined databases and VA administrative claims data from 2010 through 2013. Study subjects at VA hospitals were younger and typically were less likely to be white than those in non-VA hospitals.

In analyses adjusting for risks (i.e., age, patient conditions), VA hospitals had lower mortality rates for AMI and HF than non-VA hospitals but a higher pneumonia mortality rate; percentage-point differences in mortality ranged from −0.4 to 0.5. Another analysis controlled for regional differences by comparing hospitals within metropolitan statistical areas (MSAs). VA hospitals had lower mean-aggregated within-MSA rates for AMI and HF mortality than non-VA hospitals, but rates for pneumonia mortality did not differ significantly.

Compared with non-VA hospitals, VA hospitals had higher 30-day readmission rates for all three conditions in risk-standardized analyses and had higher within-MSA mean-aggregated readmission rates.

Comment

Despite recent negative lay press about VA hospitals, these results indicate that VA care is comparable to non-VA care for men aged ≥65 with the conditions studied here. Editorialists note — and clinicians, such as myself, who work in both settings already know — that our VA patients are sicker, poorer, and more socially isolated than other patients of similar age. These differences may account for the increased risks for readmission. Support for the VA healthcare system and for care of our veterans and their families should come from multiple political and nonpolitical sources and, importantly, include grassroots clinician efforts.

Two authors of this study are members of the NEJM Journal Watch Cardiology editorial board; Dr. Harlan M. Krumholz is Editor-in-Chief and Dr. Frederick A. Masoudi is an Associate Editor. Neither was involved in the selection of the original article or in the writing or review of this summary.

Editor Disclosures at Time of Publication

  • Disclosures for Joel M. Gore, MD at time of publication Grant / Research support NIH-NHLBI

Citation(s):

Reader Comments (1)

ANITA JENSEN Other Healthcare Professional, Epidemiology/Statistics, Indian Health Services

I agree with the great comment above. Also, could these high readmission rates be due to Third-party Payer-driven short hospital stays? Are we sending them home too soon, before they are really able to effectively care for themselves and/or their condition?

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