VA hospitals compare favorably on deaths, readmission rates

CHICAGO — Veterans' hospitals compare pretty favorably with others when it comes to treating older men with three common conditions — heart attacks, heart failure and pneumonia, according to a study on death rates and readmissions.

Chances for dying or being readmitted within 30 days of treatment for those conditions varied only slightly for patients hospitalized within the VA system versus at outside hospitals, the 2010-2013 study found.

The results contrast with longstanding concerns about challenges facing veterans and the VA health system, including quality questions and long waits for care. They suggest that VA hospitals "are still able to deliver high-quality care for some of the sickest most complicated patients," Dr. Ashish Jha, a Harvard health policy expert, said in an editorial published Tuesday with the study in the Journal of the American Medical Association.

The study analyzed claims for men aged 65 and older treated at 104 VA hospitals and for male Medicare patients treated at 1,513 non-VA hospitals nationwide. Each comparison involved at least 7,900 patients.

At VA hospitals, death rates were marginally lower after a heart attack — 13.5 percent vs 13.7 percent; and for heart failure — 11.4 percent vs 11.9 percent. They were slightly higher for pneumonia — 12.6 percent vs. 12.2 percent at non-VA hospitals.

Readmission rates ranged from about 17 percent to 25 percent for the three conditions and were highest at VA hospitals, but only by about 1 percentage point or less.

"Both groups are now working on quality in ways they didn't a decade ago and the levels of good performance are quite comparable" for the conditions studied, said lead author Dr. Harlan Krumholz, a Yale University cardiologist and researcher.

The efforts include online sites allowing consumers to compare patient outcomes for the three conditions studied at VA hospitals and others nationwide, and growing use of pilot-style checklists during hospital procedures to verify appropriate treatment.

Still, Krumholz said the overall results aren't ideal.

"Readmissions are still way too high and we haven't made enough progress there," he said.

Lower readmission rates at non-VA hospitals may partly reflect the impact of financial penalties the Medicare system introduced in 2012 to reduce readmissions. But also, VA patients tend to be sicker and travel farther for care, which could lead to more readmissions, the researchers said.

Dr. David Shulkin, the VA's undersecretary for health, said the results are not surprising and they debunk "the impression that the VA has fallen behind. This really is validation" that VA employees "are really doing a very good job and keeping focused on doing what's right for veterans."

Krumholz noted that the study doesn't address quality of care for young patients, women and those with conditions other than those studied.

Jha, the editorial author, said other important questions about VA hospitals remain, including timeliness of care and whether veterans perceive that they are treated with respect.