Weinberger commentary examines hospital readmission data for veterans

Dr. Morris Weinberger

Weinberger is Vergil N. Slee Distinguished Professor of Healthcare Quality Management in the health policy and management department in Gillings School of Global Public Health at The University of North Carolina in Chapel Hill. He also is senior research career scientist at the Center for Health Services Research in Primary Care, at the Veterans Affairs Medical Center (VAMC) in Durham, N.C.
His co-author, Eugene Oddone, MD, MHSc, is professor of medicine at Duke University and director of the VAMC health services research center.

Weinberger and Oddone reviewed research conducted by Peter Kaboli, MD, and colleagues, in the article, “Associations Between Reduced Hospital Length of Stay and 30-Day Readmission Rate and Mortality: 14-Year Experience in 129 Veterans Affairs Hospitals,” also published in the Dec. 18 issue of Annals of Internal Medicine.

Kaboli and colleagues examined the relationship between hospital length of stay, hospital readmission rates and mortality for more than four million U.S. veterans over a 14-year period. They showed that over that period, average length of stay decreased by 27 percent, while hospital readmissions within a 30-day period decreased by 25 percent and 90-day mortality rates improved.

In their article, “Hospital Readmission Rates: Are We Measuring the Right Thing?,” Weinberger and Oddone ask whether hospital readmission is a quality indicator of successful hospital treatment.

“It’s not only quality of care during the index hospitalization or the quality of the handoff to post-discharge care,” they write. “Rather many important factors affect when and how often patients are hospitalized, including access to post-discharge care, ability to purchase evidence-based medications or services prescribed at discharge, disease and disease severity, socio-economic status, community resources and social support.”

The authors reference their earlier research showing that attempts to improve certain of these factors actually resulted in an increase in re-hospitalizations in veterans’ medical centers, but also an increase in patients’ satisfaction with their care. The authors suggest that ‘preventable’ re-hospitalizations might be a better measure of successful treatment, despite that descriptor’s being difficult to define.

“Better defining the unique factors that explain hospital readmission, and chipping away at them, must be a goal of effective health-care systems,” they write. “Perhaps it is time to embrace the VA as the largest U.S. accountable care organization. Let the VA serve as an example of how to enhance both efficiency (reduced length of stay) and quality (reduced readmission rates and mortality). Understanding the effect of the transformation of the VA health care system provides valuable lessons as hospitals and provider organizations partner to share responsibility for the health of defined populations.”

UNC Gillings School of Global Public Health contact: David Pesci, director of communications, (919) 962-2600 or dpesci@unc.edu.