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Length-of-Stay, Readmissions Down in VA Hospitals

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Length-of-Stay, Readmissions Down in VA Hospitals

But hospitals with lower than expected length of stay have higher readmission rates

TUESDAY, Dec. 18 (HealthDay News) -- Over a 14-year period (1997 to 2010), the risk-adjusted hospital length of stay (LOS) and hospital readmission rates decreased throughout Veterans Affairs hospitals, according to a study published in the Dec. 18 issue of the Annals of Internal Medicine.

Peter J. Kaboli, M.D., from the Iowa City Veterans Affairs Healthcare System, and colleagues evaluated 4,124,907 medical admissions from all 129 acute care Veterans Affairs hospitals in the United States to determine trends in hospital LOS and 30-day readmission rates. Sub-analysis was conducted for all medical diagnoses combined and for five common diagnoses.

The researchers found that for all medical diagnoses combined the risk-adjusted mean hospital LOS decreased significantly, from 5.44 to 3.98 days, or 2 percent annually. For the five specific diagnoses, LOS also decreased, with greatest reductions for acute myocardial infarction (2.85 days) and community-acquired pneumonia (2.22 days). Risk-adjusted 30-day readmission rates for all medical diagnoses combined also decreased significantly over the 14 years, from 16.5 to 13.8 percent, as did reductions in readmissions for the five specific common diagnoses. The greatest readmission reductions occurred for acute myocardial infarction (22.6 to 19.8 percent) and chronic obstructive pulmonary disease (17.9 to 14.6 percent). There was a 3 percent annual reduction in all-cause mortality 90 days after admission. Hospitals with a lower than expected mean risk-adjusted LOS had a higher readmission rate (a 6 percent increase in readmission for each day lower than expected).

"Veterans Affairs hospitals demonstrated simultaneous improvements in hospital LOS and readmissions over 14 years, suggesting that, as LOS improved, hospital readmission did not increase," the authors write.

Full Text (subscription or payment may be required) (http://annals.org/article.aspx?articleid=1485308 )Editorial (subscription or payment may be required) (http://annals.org/article.aspx?articleid=1485312 )