Abstract 320: 30-Day Outcome and Processes of Care for Patients Hospitalized for Heart Failure at Veteran and Non-Veteran US Hospitals

Abstract

Background: Mortality and readmission at 30 days following admission for heart failure (HF) and acute myocardial infarction (AMI) are now publically reported for US hospitals. It is unclear if outcome is similar for veteran (VA) and non-VA facilities. Methods: We used data from Hospital Compare of the Center for Medicare and Medicaid Services (CMS) that includes hospital specific processes of care and 30-day mortality and 30-day all-cause readmission rates adjusted for patient characteristics for US hospitals from 2010-2011. VA hospitals were compared to other adult hospitals on 30-day mortality, 30-day all-cause readmission, documentation of left ventricular ejection fraction (EF), discharge instructions, smoking cession counseling and use of angiotensin converting enzyme (ACE) inhibitors if the LVEF was < 40%. Hospitals with fewer than 25 cases were excluded. Multivariate analyses of 30-day mortality and 30-day readmission were conducted to determine the impact of controlling for rates of process of HF care on the association with admission to a VA hospital. All analyses were weighted for the number of discharges per facility. Results: 30-day mortality was lower and 30-day readmission was higher for those hospitalized at VA facilities (Table). Process of care was high for most hospitals with the VA hospitals having slightly higher rates for all process measures which were significant for documentation of EF and discharge instructions. Hospitalization at a VA was associated with a 0.47% lower 30-day mortality rate which was reduced to a 0.43% lower rate (p=0.006) after adjustment for processes of care. In contrast, hospitalization at a VA was associated with a 0.88% higher 30-day readmission rate which was reduced to a 0.81% greater rate (p<0.0001) after adjustment for processes of care. Conclusion: Patients hospitalized at VA hospitals had a lower 30-day mortality rate but a higher 30-day readmission rate following an admission for heart failure. Differences in process of care were small and explained only a small part of the difference in outcome between VA and non-VA hospitals.