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J Rural Health. 2009 Winter;25(1):62-9. doi: 10.1111/j.1748-0361.2009.00200.x.

Do older rural and urban veterans experience different rates of unplanned readmission to VA and non-VA hospitals?

Author information

  • 1Field Office, VA National Center for Patient Safety, White River Junction, VT 05009, USA. wbw@dartmouth.edu

Abstract

CONTEXT:

Unplanned readmission within 30 days of discharge is an indicator of hospital quality.

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.

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.

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.

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.

PMID:
19166563
[PubMed - indexed for MEDLINE]
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