3152 — Is Hospital Distance Associated with 30-Day Readmission among VA Enrollees?

Wong ES, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Hebert PL, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Rinne ST, VA Connecticut Healthcare System, West Haven, CT; Au DH, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; Liu CF, Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA;

Objectives:
Access to care remains a challenging problem in VA stemming, in part, from a large population of rural VA enrollees. Distance is a robust predictor of VA outpatient utilization, however, the influence of distance on VA inpatient utilization has been analyzed less extensively. This study examined the association between distance from Veterans' residence to the nearest VA or non-VA hospital and 30-day disease specific readmission. We examined hospitalizations for congestive heart failure (CHF) and chronic obstructive pulmonary disease (COPD), the two leading causes of hospitalization in VA.

Methods:
Using VA administrative data, we identified 35,030 Veterans hospitalized in VA for CHF during fiscal year (FY) 2007-2009 and 22,658 Veterans hospitalized in VA for COPD during FY2008-2010. Outcome variables were dichotomous measures denoting rehospitalization (in VA or Medicare) for the same condition within 30 days following discharge. Distance to the nearest hospital was defined as the number of miles between Veterans' residence zip code and the zip code of the nearest hospital (VA or Medicare) and was categorized into quartiles. The relationship between distance and readmission probability was estimated using binary choice models, controlling for demographics, comorbidity, prior utilization, residence county characteristics and discharge hospital fixed effects.

Results:
Rates of 30-day disease specific readmission were 11.2% and 9.2% for CHF and COPD, respectively. Mean hospital distance was 11.6 miles (interquartile range (IQR) = 0.9 to 12.8 miles) among CHF patients and 5.1 miles (IQR = 1.5 to 14.4 miles) among COPD patients. For CHF, predicted readmission rates were 11.7%, 11.2%, 10.9% and 11.2% for the closest through furthest distance quartiles, respectively. For COPD, predicted readmission rates were 9.4%, 9.7%, 9.3% and 8.3% for the closest through furthest distance quartiles, respectively. Readmission rate differences across quartiles were not statistically significant for both disease cohorts.

Implications:
Greater hospital distance was not associated with higher readmission rates among Veterans hospitalized for two of the leading causes of hospitalization in VA.

Impacts:
In contrast to prior findings related to VA outpatient utilization, readmissions among Veterans hospitalized for CHF and COPD were not sensitive to hospital distance. These findings suggest hospital readmissions have a larger non-discretionary component relative to outpatient utilization.