Study: Shorter stays but lower rehospitalization and death rates at VA hospitals

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Quicker hospital discharges have not led to increased readmissions or deaths, according to a study of Veterans Administration hospitals published Tuesday.

Lengths of stay decreased 27% between 1997 and 2010, while rehospitalization and death rates also dropped, say researchers based at the VA Medical Center in Iowa City, IA. They examined data from 4 million patients at 129 U.S. Veterans Administration hospitals to reach their conclusions.

"Over 14 years, the VA and other health care systems have been trying to improve efficiency, moving patients through the hospital quicker," said Peter Kaboli, M.D., a hospitalist. "It's costly to be in the hospital, and patients prefer to go home.”

Attention was given to five common health problems: heart failure, chronic obstructive pulmonary disease (COPD), heart attack, pneumonia and gastrointestinal bleeding.

The researchers looked at length of stay and rate of re-admission within 30 and 90 days after discharge. Lengths of stay decreased 27% and readmissions rates decreased 16 percent, Kaboli said. Death rates after one and three months also were monitored, and were found to have dropped about 3% in both time frames.

However, when patients were released too soon, the risk for rehospitalization rose 6% for each day they were released early, the researchers discovered.

Kaboli believes the improvements demonstrate better coordination between hospital and outpatient services, and a focus on care and patient safety. In addition, the greater use of hospitalists — doctors who provide care only in the hospital — is associated with higher quality care, he said.

Whether the same results are true in private hospitals, where lengths of stay also have declined, isn't known, Kaboli said. The study was published in the Annals of Internal Medicine.

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