In the Journals

Cost, mortality rates elevated among veterans receiving PCI at community care sites

Among veterans undergoing elective PCI, mortality and costs were lower in those who had their procedures at Veterans Affairs hospitals vs. those who had them at community care sites, according to results recently published in JAMA Cardiology.

However, mortality did not differ by site type for veterans undergoing elective CABG, and costs were lower in community care centers, researchers reported.

Paul G. Barnett, PhD, from the VA Health Economics Resource Center and the VA Palo Alto Health Care System, and colleagues conducted an observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization at VA and community care hospitals to compare access, cost and quality of elective coronary revascularization procedures between the site types and to evaluate whether procedural volume or publicly reported quality data can be used to analyze high-value care.

The study included 13,237 veterans undergoing elective PCI and 5,818 veterans undergoing elective CABG procedures and controlled for differences in risk factors using propensity adjustment.

Outcomes of interest were travel distance, 30-day mortality and costs.

Net travel was reduced by 53.6 miles for community care vs. VA-only care in the PCI cohort and by 73.3 miles in the CABG cohort.

Mortality rates

There was a higher rate of adjusted 30-day mortality after PCI in those who visited community care hospitals compared with VA sites (1.54% vs. 0.65%; P<.001), but 30-day mortality rates did not differ by site type in the CABG cohort (community care, 1.33%; VA, 1.51%; P=.74).

Additionally, there was no difference in adjusted 30-day readmission rates for PCI (community care, 7.04%; VA, 7.73%; P=.66) or CABG (community care, 8.13%; VA, 7%; P=.28).

In the PCI cohort, mean adjusted costs were higher in the community care group vs. the VA group ($22,025 vs. 15,683; P < .001). However, in the CABG cohort, mean adjusted costs were lower in the community care group ($55,526 vs. $63,144; P < .01).

CABG mortality was lower in small-volume community care hospitals.

High-quality care

“To ensure that veterans receive care that is timely, accessible and of the highest quality, policymakers should consider providing information to help veterans seek care from the highest-value hospitals and health care professionals regardless of whether the hospitals are VA or [community care],” Barnett and colleagues wrote.

“Perhaps a future requirement for participation in the [community care] program should be an explicit commitment to engage in quality monitoring and improvement efforts in conjunction with the VA to identify opportunities to improve the care at all centers,” Frederic S. Resnic, MD, MSc, from the department of cardiovascular medicine at the Lahey Hospital and Medical Center, and Gautam Gadey, MD, from Tufts School of Medicine, wrote in a related editorial. “In addition, we believe the VA should actively monitor the clinical outcomes and costs at [community care] hospitals and provide this information to veterans and their VA clinicians to help them choose the most appropriate setting for their individual needs for coronary revascularization.”– by Dave Quaile

Disclosures: The authors, Gadey and Resnik report no relevant financial disclosures.

 

Among veterans undergoing elective PCI, mortality and costs were lower in those who had their procedures at Veterans Affairs hospitals vs. those who had them at community care sites, according to results recently published in JAMA Cardiology.

However, mortality did not differ by site type for veterans undergoing elective CABG, and costs were lower in community care centers, researchers reported.

Paul G. Barnett, PhD, from the VA Health Economics Resource Center and the VA Palo Alto Health Care System, and colleagues conducted an observational cohort study of veterans younger than 65 years undergoing an elective coronary revascularization at VA and community care hospitals to compare access, cost and quality of elective coronary revascularization procedures between the site types and to evaluate whether procedural volume or publicly reported quality data can be used to analyze high-value care.

The study included 13,237 veterans undergoing elective PCI and 5,818 veterans undergoing elective CABG procedures and controlled for differences in risk factors using propensity adjustment.

Outcomes of interest were travel distance, 30-day mortality and costs.

Net travel was reduced by 53.6 miles for community care vs. VA-only care in the PCI cohort and by 73.3 miles in the CABG cohort.

Mortality rates

There was a higher rate of adjusted 30-day mortality after PCI in those who visited community care hospitals compared with VA sites (1.54% vs. 0.65%; P<.001), but 30-day mortality rates did not differ by site type in the CABG cohort (community care, 1.33%; VA, 1.51%; P=.74).

Additionally, there was no difference in adjusted 30-day readmission rates for PCI (community care, 7.04%; VA, 7.73%; P=.66) or CABG (community care, 8.13%; VA, 7%; P=.28).

In the PCI cohort, mean adjusted costs were higher in the community care group vs. the VA group ($22,025 vs. 15,683; P < .001). However, in the CABG cohort, mean adjusted costs were lower in the community care group ($55,526 vs. $63,144; P < .01).

CABG mortality was lower in small-volume community care hospitals.

High-quality care

“To ensure that veterans receive care that is timely, accessible and of the highest quality, policymakers should consider providing information to help veterans seek care from the highest-value hospitals and health care professionals regardless of whether the hospitals are VA or [community care],” Barnett and colleagues wrote.

“Perhaps a future requirement for participation in the [community care] program should be an explicit commitment to engage in quality monitoring and improvement efforts in conjunction with the VA to identify opportunities to improve the care at all centers,” Frederic S. Resnic, MD, MSc, from the department of cardiovascular medicine at the Lahey Hospital and Medical Center, and Gautam Gadey, MD, from Tufts School of Medicine, wrote in a related editorial. “In addition, we believe the VA should actively monitor the clinical outcomes and costs at [community care] hospitals and provide this information to veterans and their VA clinicians to help them choose the most appropriate setting for their individual needs for coronary revascularization.”– by Dave Quaile

Disclosures: The authors, Gadey and Resnik report no relevant financial disclosures.