(Reuters Health) – For older men with heart attack, heart failure or pneumonia, being treated at a Veteran’s Affairs (VA) hospital carries similar risks of death or hospital readmission compared to other facilities, according to a new study.
Rates of death from any cause within 30 days of admission were slightly lower at VA hospitals, and hospital readmission rates were slightly higher, but the differences were very small, researchers found.
“There’s been a lot of recent concern about care in the VA,” said senior author Dr. Harlan M. Krumholz of Yale-New Haven Hospital in Connecticut.
To see how VA care compares with treatment at other private and public hospitals, Krumholz and a colleague looked at outcomes for men over 65 years old. This group would likely be covered by Medicare, the government insurance program for older people, and could, in principle, choose to be treated at VA hospitals or elsewhere.
The VA and the Centers for Medicare and Medicaid Services are also collaborating to align their measures of hospital performance, which makes it easier to compare them, the study team writes in JAMA.
The researchers analyzed outcomes for three high-risk acute illnesses that require rapid and effective interventions among older men, as VA facilities serve more men than women and as comparison data from Medicare is more comprehensive for older patients, Krumholz told Reuters Health.
The researchers considered male Medicare beneficiaries age 65 and older who were hospitalized for heart attack, heart failure or pneumonia between 2010 and 2013 in 104 VA hospitals and more than 1,500 acute care hospitals. The facilities covered 92 metropolitan areas in the U.S.
For heart attack and heart failure, 30-day mortality rates were slightly lower at VA hospitals, while pneumonia deaths were slightly higher, but the differences were all less than one percentage point. Hospital readmissions for all three conditions were higher in VA hospitals, but the differences were also small.
“We know that what drives readmissions is how sick and how poor the population is,” said Dr. Ashish K. Jha of the Harvard T. H. Chan School of Public Health in Boston who wrote an editorial accompanying the new results. “The VA’s patients are sicker and poorer than the general population – and thus, we would have expected the risk-adjusted readmission rates to be higher,” which they were, Jha said.
But it is reassuring that mortality rates did not appear to suffer, Jha told Reuters Health by email.
“The systems are doing about the same, there’s no evidence that veterans are getting worse care in the VA,” at least according to these results, Krumholz said.
But this study did not include comparisons of outcomes for less acute conditions, wait times for care or costs, as it is much harder to make those comparisons, said lead author Dr. Sudhakar Nuti, also of Yale-New Haven Hospital.
“It will remain critical to continue to monitor these outcome metrics to elevate the entire performance curve,” Nuti told Reuters Health.
The VA is essentially a single-payer system within the larger U.S. healthcare landscape, Krumholz said.
“Some people think the sky is going to fall under a system like that,” but the new results are fairly reassuring, he said.
Both VA and other hospital facilities have been improving their care outcomes for the last two decades, he said.
“There are probably things for each system to learn from each other,” in order to keep improving, he said.
In the past, highlighting particular facilities with the best mortality and readmission outcomes has helped spread best practices through the whole system, Nuti said. Medicare reimbursement already incentivizes better outcomes, like lower readmission rates, for hospitals, he said.
The VA should be working on improving their pneumonia care because it still isn’t where it should be, Jha said. “Second, there is still plenty of variation within the VA system and while on average, VA hospitals are doing well for (heart attack) and (heart failure), the truth is that there are plenty of low performing VA hospitals that could be improved.”
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