Abstract 2: Facility-level Variation in 30-day PCI Mortality, Readmission, and Costs in the VA Health Care System: Insights About Short-term Healthcare Value From The VA CART Program
Background: Value in health care, defined as the health outcomes achieved per dollar spent, is emerging as a framework for improvement in health care delivery. We sought to describe facility-level variation in 30-day PCI mortality, readmission and costs.
Methods: Using national data from the VA CART Program, we evaluated all patients who had PCI from 2008 to 2010. 30-day total patient costs, readmission, and mortality were attributed to the hospital where the PCI was performed. Risk standardized costs and outcomes were calculated using standardized covariates, adjusting for cardiac and non-cardiac comorbidities.
Results: There were 60 hospitals (21,173 patients) that performed more than 20 PCIs during the study period with a mean of 353 PCIs. The unadjusted mean mortality rate was 2.5%, with no significant variation in facility-level risk standardized mortality. The unadjusted mean readmission rate was 10.6%. The risk standardized readmission rate ranged from 0.8 to 1.58 times the average, with 2 hospitals significantly below and 8 hospitals significantly above the risk standardized average. The facility-level median per patient total costs was $26,491 (IQR $20,943 to $31,866). The index hospitalization accounted for 42.4% of 30-day total costs, and readmission accounted for 5.6% of the 30-day total costs at the facility-level. Comparison of risk standardized costs identified 17 hospitals with lower than expected costs and 15 hospitals with higher than expected costs. Facilities with low readmission rates were not overrepresented among low cost facilities, suggesting readmissions are not a major contributor to facility-level 30-day cost (Figure).
Conclusion: We observed no variation in facility-level 30-day PCI mortality despite large variation in cost. Although readmission rates varied, readmission accounted for less than 6% of 30-day cost and was not related to facility-level costs. Further studies are needed to determine factors associated with high-value PCI care, defined by low morbidity and mortality despite similar or lower costs.
Author Disclosures: S.M. Bradley: None. C.I. O'Donnell: None. G.K. Grunwald: None. T.M. Maddox: None. S.D. Fihn: None. R.L. Jesse: None. J.S. Rumsfeld: None. P. Ho: None.
- © 2014 by American Heart Association, Inc.