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Do older rural and urban veterans experience different rates of unplanned readmission to VA and non-VA hospitals?
- Source :
-
The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association [J Rural Health] 2009 Winter; Vol. 25 (1), pp. 62-9. - Publication Year :
- 2009
-
Abstract
- Context: Unplanned readmission within 30 days of discharge is an indicator of hospital quality.<br />Purpose: We wanted to determine whether older rural veterans who were enrolled in the VA had different rates of unplanned readmission to VA or non-VA hospitals than their urban counterparts.<br />Methods: We used the combined VA/Medicare dataset to examine 3,513,912 hospital admissions for older veterans that occurred in VA or non-VA hospitals between 1997 and 2004. We calculated 30-day readmission rates and odds ratios for rural and urban veterans, and we performed a logistic regression analysis to determine whether living in a rural setting or initially using the VA for hospitalization were independent risk factors for unplanned 30-day readmission, after adjusting for age, sex, length of stay of the index admission, and morbidity.<br />Findings: Overall, rural veterans had slightly higher 30-day readmission rates than their urban counterparts (17.96% vs 17.86%; OR 1.006, 95% CI: 1.0004, 1.013). For both rural- and urban-dwelling veterans, readmission after using a VA hospital was more common than after using a non-VA hospital (20.7% vs 16.8% for rural veterans, 21.2% vs 16.1% for urban veterans). After adjusting for other variables, readmission was more likely for rural veterans and following admission to a VA hospital.<br />Conclusions: Our findings suggest that VA should consider using the unplanned readmission rate as a performance metric, using the non-VA experience of veterans as a performance benchmark, and helping rural veterans select higher performing non-VA hospitals.
- Subjects :
- Age Factors
Aged
Diagnosis-Related Groups classification
Female
Health Care Surveys
Hospitals, Community standards
Hospitals, Veterans standards
Humans
Male
Medicare standards
Middle Aged
Risk Factors
United States
Utilization Review
Veterans classification
Benchmarking
Hospitals, Community statistics & numerical data
Hospitals, Veterans statistics & numerical data
Patient Readmission statistics & numerical data
Quality Indicators, Health Care
Rural Population statistics & numerical data
Urban Population statistics & numerical data
Veterans statistics & numerical data
Subjects
Details
- Language :
- English
- ISSN :
- 1748-0361
- Volume :
- 25
- Issue :
- 1
- Database :
- MEDLINE
- Journal :
- The Journal of rural health : official journal of the American Rural Health Association and the National Rural Health Care Association
- Publication Type :
- Academic Journal
- Accession number :
- 19166563
- Full Text :
- https://doi.org/10.1111/j.1748-0361.2009.00200.x