Peter J. Kaboli, MD, MS; Jorge T. Go, MD, MS; Jason Hockenberry, PhD; Justin M. Glasgow, BS, MS; Skyler R. Johnson, BS, MS; Gary E. Rosenthal, MD; Michael P. Jones, PhD; Mary Vaughan-Sarrazin, PhD
Presented in part at the annual meeting of the Society of Hospital Medicine, Washington, DC, 14 May 2009.
Disclaimer: The authors had full access to and take full responsibility for the integrity of the data. The views expressed in this article are those of the authors and do not necessarily represent the views of the U.S. Department of Veterans Affairs.
Grant Support: By the Office of Rural Health and the Health Services Research & Development Service, Veterans Health Administration, U.S. Department of Veterans Affairs, Veterans Rural Health Resource Center–Central Region, and the Center for Comprehensive Access & Delivery Research and Evaluation at the Iowa City Veterans Affairs Healthcare System (HFP 04-149). Dr. Go was supported by the Veterans Affairs Quality Scholars Fellowship Program, Veterans Affairs Office of Academic Affiliations.
Potential Conflicts of Interest: Disclosures can be viewed at www.acponline.org/authors/icmje/ConflictOfInterestForms.do?msNum=M10-1365.
Reproducible Research Statement: Study protocol and statistical code: Available from Dr. Kaboli (e-mail, firstname.lastname@example.org). Data set: Not available.
Requests for Single Reprints: Peter J. Kaboli, MD, MS, Iowa City Veterans Affairs Healthcare System, Comprehensive Access & Delivery Research and Evaluation Center, Mailstop 152, 601 Highway 6 West, Iowa City, IA 52246; e-mail, email@example.com.
Current Author Addresses: Dr. Kaboli: Iowa City Veterans Affairs Healthcare System, Comprehensive Access & Delivery Research and Evaluation Center, Mailstop 152, 601 Highway 6 West, Iowa City, IA 52246.
Dr. Go: Department of Internal Medicine, Division of Gastroenterology, University of Iowa Carver College of Medicine, 200 Hawkins Drive, Iowa City, IA 52242.
Dr. Hockenberry: Department of Health Policy and Management, Rollins School of Public Health, Emory University, 1518 Clifton Road, Atlanta, GA 30329.
Mr. Glasgow, Ms. Johnson, and Drs. Rosenthal and Vaughan-Sarrazin: Iowa City Veterans Affairs Healthcare System, 601 Highway 6 West, Iowa City, IA 52246.
Dr. Jones: Department of Biostatistics, University of Iowa College of Public Health, 105 River Street, Iowa City, IA 52245.
Author Contributions: Conception and design: P.J. Kaboli, J.T. Go, J. Hockenberry, J.M. Glasgow, G.E. Rosenthal, M. Vaughan-Sarrazin.
Analysis and interpretation of the data: P.J. Kaboli, J.T. Go, J. Hockenberry, J.M. Glasgow, S.R. Johnson, M.P. Jones, M. Vaughan-Sarrazin.
Drafting of the article: P.J. Kaboli, J.T. Go, J.M. Glasgow, M. Vaughan-Sarrazin.
Critical revision of the article for important intellectual content: P.J. Kaboli, J.T. Go, J. Hockenberry, J.M. Glasgow, G.E. Rosenthal, M. Vaughan-Sarrazin.
Final approval of the article: P.J. Kaboli, J. Hockenberry, J.M. Glasgow, S.R. Johnson, G.E. Rosenthal, M. Vaughan-Sarrazin.
Provision of study materials or patients: P.J. Kaboli.
Statistical expertise: J.T. Go, S.R. Johnson, M.P. Jones, M. Vaughan-Sarrazin.
Obtaining of funding: P.J. Kaboli.
Administrative, technical, or logistic support: P.J. Kaboli.
Collection and assembly of data: P.J. Kaboli, S.R. Johnson, M. Vaughan-Sarrazin.
Kaboli PJ, Go JT, Hockenberry J, Glasgow JM, Johnson SR, Rosenthal GE, et al. Associations Between Reduced Hospital Length of Stay and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals. Ann Intern Med. 2012;157:837-845. doi: 10.7326/0003-4819-157-12-201212180-00003
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Published: Ann Intern Med. 2012;157(12):837-845.
Reducing length of stay (LOS) has been a priority for hospitals and health care systems. However, there is concern that this reduction may result in increased hospital readmissions.
To determine trends in hospital LOS and 30-day readmission rates for all medical diagnoses combined and 5 specific common diagnoses in the Veterans Health Administration.
Observational study from 1997 to 2010.
All 129 acute care Veterans Affairs hospitals in the United States.
4 124 907 medical admissions with subsamples of 2 chronic diagnoses (heart failure and chronic obstructive pulmonary disease) and 3 acute diagnoses (acute myocardial infarction, community-acquired pneumonia, and gastrointestinal hemorrhage).
Unadjusted LOS and 30-day readmission rates with multivariable regression analyses to adjust for patient demographic characteristics, comorbid conditions, and admitting hospitals.
For all medical diagnoses combined, risk-adjusted mean hospital LOS decreased by 1.46 days from 5.44 to 3.98 days, or 2% annually (P < 0.001). Reductions in LOS were also observed for the 5 specific common diagnoses, with greatest reductions for acute myocardial infarction (2.85 days) and community-acquired pneumonia (2.22 days). Over the 14 years, risk-adjusted 30-day readmission rates for all medical diagnoses combined decreased from 16.5% to 13.8% (P < 0.001). Reductions in readmissions were also observed for the 5 specific common diagnoses, with greatest reductions for acute myocardial infarction (22.6% to 19.8%) and chronic obstructive pulmonary disease (17.9% to 14.6%). All-cause mortality 90 days after admission was reduced by 3% annually. Of note, hospitals with mean risk-adjusted LOS that was lower than expected had a higher readmission rate, suggesting a modest tradeoff between hospital LOS and readmission (6% increase for each day lower than expected).
This study is limited to the Veterans Health Administration system; non–Veterans Affairs admissions were not available. No measure of readmission preventability was used.
Veterans Affairs hospitals demonstrated simultaneous improvements in hospital LOS and readmissions over 14 years, suggesting that as LOS improved, hospital readmission did not increase. This is important because hospital readmission is being used as a quality indicator and may result in payment incentives. Future work should explore these relationships to see whether a tipping point exists for LOS reduction and hospital readmission.
Office of Rural Health and the Health Services Research & Development Service, Veterans Health Administration, U.S. Department of Veterans Affairs.
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