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Is Hospital Distance Associated with 30-Day Readmission among VA Enrollees?
Wong ES, Hebert PL, Rinne ST, Au DH, Liu C. Is Hospital Distance Associated with 30-Day Readmission among VA Enrollees? Poster session presented at: AcademyHealth Annual Research Meeting; 2015 Jun 14; Minneapolis, MN.
1Center of Innovation for Veteran-Centered and Value-Driven Care, VA Puget Sound Health Care System, Seattle, WA; 2Department of Health Services, University of Washington, Seattle, WA; 3Department of Medicine, University of Washington, Seattle, WA
Objective: The Department of Veterans Affairs Health Care System (VA) is the largest integrated health system in the United States, however, access to VA care is challenging for many veteran enrollees. Challenges in access, in part, stem from a large population of rural VA enrollees. Prior research indicates 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 VA enrollees' 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.
Study Design: Using VA and Medicare administrative data, we identified patients who were hospitalized for CHF or COPD in VA hospitals. Outcome variables were dichotomous measures denoting whether patients were rehospitalized (in VA or fee-for-service Medicare) for the same condition within 30 days following discharge. Distance to the nearest hospital was defined as the number of miles between patients' residence zip code and the zip code of the nearest hospital (VA or FFS Medicare). We calculated distance based on the Haversine formula and categorized distance into quartiles. To estimate the association between hospital distance and readmission probability, we estimated binary choice models, controlling for demographics, comorbidity, prior health care utilization, characteristics of patients' county of residence and discharge hospital fixed effects. We performed analyses separately by disease cohort.
Population Studied: 35,030 patients hospitalized for CHF during fiscal year (FY) 2007-2009 and 22,658 patients hospitalized for COPD in FY2008-2010 after excluding patients enrolled in Medicare Advantage plans at discharge.
Principal Findings: The rates of 30-day disease specific readmission were 11.2% and 9.2% for CHF and COPD, respectively. Mean distance to the nearest hospital was 11.6 miles (interquartile range (IQR) = 0.9 to 12.8 miles) among CHF patients and 5.1 (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.
Conclusions: Greater hospital distance was not associated with higher readmission rates among veterans hospitalized for two of the leading causes of hospitalization in VA.
Implications for Policy, Delivery or Practice: In contrast to prior findings related to VA outpatient utilization, readmissions among patients 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.