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December 26, 2024JAMA Network OpenOpen Access

Using VHA and non-VHA readmissions, 24 VHA hospitals (23.1%) improved performance and 23 hospitals (22.1%) worsened performance by 1 or more quintiles compared to VHA-only readmissions.

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Why the study?

Most routinely reported VHA performance measures exclude readmissions outside VHA hospitals, and the impact of non-VHA readmissions on hospital risk-standardized 30-day readmission rates was unknown.

Population

108 265 surgical patients aged at least 65 years across 104 VHA hospitals

Comparison

VHA plus non-VHA readmissions vs VHA-only readmissions

Design

Retrospective cohort study

Follow-up

30 days

Authors

MVMary Vaughan‐SarrazinYGYubo GaoCJCarly A. Jacobs

Discussion

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Overview

VHA readmission rankings may misrepresent performance without non-VHA data; this observational finding leaves open whether comprehensive capture should guide assessments.

Structured PICO

P
Population
108,265 patients aged ≥65 years undergoing surgery in 104 VHA hospitals between 2013-2019, with VHA and Medicare enrollment during the year prior to surgery. Mean age 72.2, 97.6% male.
I
Intervention
Calculation of 30-day hospital risk-standardized readmission rates (RSRRs) including both VHA and non-VHA readmissions
C
Comparator
Calculation of RSRRs using VHA-only readmissions
O
Outcome
Readmissions to acute care VHA or non-VHA hospitals within 30 days of discharge and changes in hospital performance quintiles

Including non-VHA readmissions significantly alters VHA hospital performance rankings, with hospitals having higher patient volume, higher complexity, and lower proportion of outside care showing improved metrics.

Cite This Study

Vaughan‐Sarrazin et al. (2024) studied this question.

synapsesocial.com/papers/6a1e0abb4dc08b4b569fc7bdhttps://doi.org/10.1001/jamanetworkopen.2024.52056
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Descriptive Analysis of 30-Day Readmission After Inpatient Surgery Discharge in the Veterans Health Administration2014 · 44 citations
  2. 2Medical and Surgical Readmissions in the Veterans Health Administration2013 · 38 citations
  3. 3Examining the Utility of 30‐day Readmission Rates and Hospital Profiling in the Veterans Health Administration2019 · 2 citations
  4. 4Trends in Readmission and Mortality Rates Following Heart Failure Hospitalization in the Veterans Affairs Health Care System From 2007 to 20172020 · 50 citations
  5. 5The Relationship Between Timing of Surgical Complications and Hospital Readmission2014 · 164 citations