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Mortality and length of stay in a veterans affairs hospital and private sector hospitals serving a common market

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Abstract

OBJECTIVE: To compare severity-adjusted in-hospital mortality and length of stay (LOS) in a Veterans Administration (VA) hospital and private sector hospitals serving the same health care market.

DESIGN: Retrospective cohort study.

SETTING: A large VA hospital and 27 private sector hospitals in the same metropolitan area.

PATIENTS: Consecutive VA (N=1,960) and private sector (N=157,147) admissions in 1994 to 1995 with 9 high-volume diagnoses.

MEASUREMENTS: Severity of illness was measured using validated multivariable models that were based on data abstracted from medical records. Outcomes were adjusted for severity and compared in VA and private sector patients using multiple logistic or linear regression analysis.

MAIN RESULTS: Unadjusted mortality was similar in VA and private sector patients (5.0% vs 5.6%, respectively; P=.26), although mean LOS was longer in VA patients (12.7 vs 7.0 days; P<.001). Adjusting for severity, the odds of death in VA patients was similar (odds ratio [OR] 1.07; 95% confidence interval [95% CI], 0.74 to 1.54; P=.73). However, a larger proportion of deaths in VA patients occurred later during hospitalization (P<.001), and the odds of death in VA patients were actually lower (P<.05) in analyses limited to deaths during the first 7 (OR, 0.56) or 14 (OR, 0.63) days. Adjusted LOS was longer (P<.001) in VA patients for all 9 diagnoses.

CONCLUSIONS: If the current findings generalizable to other markets, hospital mortality, a widely used performance measure, may be similar or lower in VA and private sector hospitals serving the same markets. The longer LOS of VA patients may reflect differences in practice patterns and may be an important source of bias in comparisons of VA and private sector hospitals.

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References

  1. Ellwod PM. Shattuck lecture. Outcomes management: a technology of patient experience. N Engl J Med. 1988;1549–56.

  2. Roper WL, Winkenwerder W, Hackbarth GM, Krakauer H. Effectiveness in health care: an initiative to evaluate and improve medical practice. N Engl J Med. 1988;319:1197–202.

    Article  PubMed  CAS  Google Scholar 

  3. QuIC Report to the President. Doing what counts for patient safety: Federal actions to reduce medical errors and their impact. Washington, DC: Quality Interagency Coordination Task Force; 1999; February 21. Available at: http://www.quic.gov. Accessed June 24, 2003.

    Google Scholar 

  4. Committee on Quality Health Care in America. Crossing the Quality Chasm: A New Health Care System for the 21st Century. Washington, DC: National Academy Press; 2001.

    Google Scholar 

  5. Khuri SF, Daley J, Henderson W, et al. The National Veterans Administration Surgical Risk Study: risk adjustment for the comparative assessment of the quality of surgical care. J Am Coll Surg. 1995;180:519–31.

    PubMed  CAS  Google Scholar 

  6. Hammermeister KE, Johnson R, Marshall G, Grover FL. Continuous assessment and improvement in quality of care. A model from the Department of Veterans Affairs Cardiac Surgery. Ann Surg. 1994;219:281–90.

    Article  PubMed  CAS  Google Scholar 

  7. Rosenthal GE, Happer DL. Cleveland Health Quality Choice: a model for community-based outcomes assessment. Jt Comm J Qual Improv. 1994;20:425–44.

    PubMed  CAS  Google Scholar 

  8. Hannan EL, Kilburn H, O’Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York state. JAMA. 1990;264:2768–74.

    Article  PubMed  CAS  Google Scholar 

  9. Hospital Effectiveness Report. Harrisburg, Pa: Pennsylvania Health Care Containment Council; 1991.

  10. Stremple JF, Bross DS, Davis CL, McDonald GO. Comparison of postoperative mortality and morbidity in VA and nonfederal hospitals. J Surg Res. 1994;56:405–16.

    Article  PubMed  CAS  Google Scholar 

  11. Stremple JF, Bross DS, Davis CL, McDonald GO. Comparison of postoperative mortality in VA and private hospitals. Ann Surg. 1993;217:277–85.

    Article  PubMed  CAS  Google Scholar 

  12. Rosenthal GE, Larimer DJ, Owens KE. Treatment of patients with acute myocardial infarction at a Veterans Administration (VA) hospital and a non-VA hospital. J Gen Intern Med. 1994;9:455–8.

    Article  PubMed  CAS  Google Scholar 

  13. Steinmiller AM. Management of uncomplicated acute myocardial infarction: are there differences in patterns of care between VAMC physicians and private practice physicians? Mil Med. 1991;3:104–7.

    Google Scholar 

  14. Heck DA, Maar DC, Lowdermilk GA, Kalasinki LA, Mesko JW. Comparative analysis of total knee arthroplasty in two health care delivery systems. J Arthroplasty. 1992;7:93–100.

    Article  PubMed  CAS  Google Scholar 

  15. Petersen LA, Normand SLT, Daley J, McNeil BJ. Outcome of myocardial infarction in veterans health administration patients compared with Medicare patients. N Engl J Med. 2000;343:1934–41.

    Article  PubMed  CAS  Google Scholar 

  16. Greenfield S, Aronow HU, Elashoff RM, Watanabe D. Flaws in mortality data: the hazards of ignoring comorbid disease. JAMA. 1988;260:2253–5.

    Article  PubMed  CAS  Google Scholar 

  17. Iezzoni LI. Data sources and implications: Administrative data-bases. In: Iezzoni LI, ed. Risk Adjustment for Measuring Health Care Outcomes, 2nd ed. Chicago, Ill: Health Administration Press; 1997:169–242.

    Google Scholar 

  18. Rosenthal GE, Harper DL, Quinn LM, Cooper GS. Severity-adjusted mortality and length of stay in teaching and non-teaching hospitals. Results of a regional study. JAMA. 1997;278:485–90.

    Article  PubMed  CAS  Google Scholar 

  19. Rosenthal GE, Quinn L, Harper DL. Declines in hospital mortality associated with a regional initiative to measure hospital performance. Am J Med Qual. 1997;12:103–12.

    PubMed  CAS  Google Scholar 

  20. Ash AS, Shwartz M. Evaluating the performance of risk-adjustment methods: dichotomous methods. In: Iezzoni LI, ed. Risk Adjustment for Measuring Health Care Outcomes, 2nd ed. Chicago, Ill: Health Administration Press; 1997:427–70.

    Google Scholar 

  21. Mixed Models Analyses Using the SAS System Course Notes. Cary, NC: SAS Institute; 2002.

  22. Thomas JW, Bates EW, Hofer T, Perkins A, Foltz-Murphy N, Webb C. Interpreting risk-adjusted length of stay patterns for VA hospitals. Med Care. 1998;36:1660–75.

    Article  PubMed  CAS  Google Scholar 

  23. Rogers JL, Feinglass J, Martin GJ, Hughes RL, Handler I, Stoms GB. Longer hospitalization at Veterans Administration hospitals than private hospitals. Verification and additional insights. Med Care. 1989;27:928–36.

    Article  PubMed  CAS  Google Scholar 

  24. Wolinsky FD, Coe RM, Mosely RR. Length of stay in the VA. Long-term care in short-term hospitals. Med Care. 1987;25:250–3.

    Article  PubMed  CAS  Google Scholar 

  25. Better Patient Management Practices Could Reduce Length of Stay in VA Hospitals. Washington, DC: General Accounting Office; 1985.

  26. Gordon HS, Fuehrer SM, Aron DC, Montague WD, Rosenthal GE. Using severity-adjusted mortality to compare performance in a Veterans Affairs (VA) hospital and in private sector hospitals. Am J Med Qual. 2000;15:207–11.

    PubMed  CAS  Google Scholar 

  27. Kaboli PJ, Barnett MJ, Fuehrer SM, Rosenthal GE. Length of stay as a source of bias in comparing performance in VA and private sector facilities: lessons learned from a regional evaluation of intensive care outcomes. Med Care. 2001;39:1014–24.

    Article  PubMed  CAS  Google Scholar 

  28. Hospital Statistics: 1996–97 Based on 1995 Data. Chicago, Ill: American Hospital Association; 1998.

  29. Covinsky KE, Justice AC, Rosenthal GE, Palmer RM, Landefeld CS. Measuring prognosis and case-mix in hospitalized elders: the importance of functional status. J Gen Intern Med. 1997;12:203–8.

    PubMed  CAS  Google Scholar 

  30. Runsfeld JS, Whinney SM, McCarthy M Jr, et al. Health-related quality of life as a predictor of mortality following coronary artery bypass graft surgery. JAMA. 1999;281:1298–303.

    Article  Google Scholar 

  31. Gordon HS, Rosenthal GE. Impact of martial status on outcomes in hospitalized patients: evidence from an academic medical center. Arch Intern Med. 1995;155:2465–71.

    Article  PubMed  CAS  Google Scholar 

  32. Shepardson LB, Younger S, Speroff T, Harper DL, Rosenthal GE. Increased risk of death in patients with do-not-resuscitate orders. Med Care. 1999;37:727–37.

    Article  PubMed  CAS  Google Scholar 

  33. Daley J, Shwartz M. Developing risk-adjustment methods. In: Iezzoni LI, ed. Risk Adjustment for Measuring Health Care Outcomes, 2nd ed. Chicago, Ill: Health Administration Press; 1997:279–329.

    Google Scholar 

  34. Miller MG, Miller LS, Fireman B, Black SB. Variation in practice for discretionary admissions: impact on estimates of quality of hospital care. JAMA. 1994;271:1493–8.

    Article  PubMed  CAS  Google Scholar 

  35. Donabedian A. The role of outcomes in quality assessment and assurance. QRB Qual Rev Bull. 1992;18:356–60.

    PubMed  CAS  Google Scholar 

  36. Dubois RW, Rogers WH, Moxley JH III, Draper D, Brook RH. Special report: hospital inpatient mortality: is it a predictor of quality? N Engl J Med. 1987;317:1674–80.

    Article  PubMed  CAS  Google Scholar 

  37. Kahn KL, Rogers WH, Rubenstein LV, et al. Measuring quality of care with explicit process criteria before and after implementation of the DRG-based prospective payment system. JAMA. 1990;264:1969–73.

    Article  PubMed  CAS  Google Scholar 

  38. Hartz AJ, Gottlieb MS, Kuhn EM, Rimm AA. The relationship between adjusted hospital mortality and the results of peer review. Health Serv Res. 1993;27:765–77.

    PubMed  CAS  Google Scholar 

  39. Thomas JW, Holloway JJ, Guire KE. Validating risk-adjusted mortality as an indicator for quality of care. Inquiry. 1993;30:6–22.

    PubMed  CAS  Google Scholar 

  40. Shinkman R. Outsourcing on the upswing. Health providers are farming out more services to spend less money. Mod Healthc. 2000;30:46–60.

    Google Scholar 

  41. Corder MP. Veteran’s health care: time for a change? Psysician Exec. 1998;24:48–51.

    CAS  Google Scholar 

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Author information

Authors and Affiliations

  1. Received from the Division of General Internal Medicine, Iowa City VA Medical Center and the University of Iowa College of Medicine, Iowa City, Iowa

    Gary E. Rosenthal MD & Mary Vaughan Sarrazin PhD

  2. Quality Information Management Corporation, USA

    Dwain L. Harper DO

  3. Cleveland VA Medical Center, Cleveland, Ohio

    Susan M. Fuehrer MBA

Authors
  1. Gary E. Rosenthal MD
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  2. Mary Vaughan Sarrazin PhD
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  3. Dwain L. Harper DO
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  4. Susan M. Fuehrer MBA
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Corresponding author

Correspondence to Gary E. Rosenthal MD.

Additional information

The views expressed in this article are those of the authors and do not necessarily represent the views of the Department of Veterans Affairs.

Dr. Rosenthal is currently a Senior Quality Scholar, Office of Academic Affiliation, Veterans Health Administration, Department of Veterans Affairs. This research was supported by an investigator-initiated award (IIR 94-093) and a Career Development Award to Dr. Rosenthal from the Health Services Research and Development Service, Veterans Health Administration, Department of Veterans Affairs.

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Rosenthal, G.E., Sarrazin, M.V., Harper, D.L. et al. Mortality and length of stay in a veterans affairs hospital and private sector hospitals serving a common market. J GEN INTERN MED 18, 601–608 (2003). https://doi.org/10.1046/j.1525-1497.2003.11209.x

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  • DOI: https://doi.org/10.1046/j.1525-1497.2003.11209.x

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