Time to untether transitional care from hospital quality: Healthcare utilization following discharge from a Department of Veterans Affairs hospital among community‐dwelling older persons
Dawn M. Bravata, Anthony J. Perkins, Laura J. Myers, Carl A. Bravata, Indrakshi Roy, Shivani K. Jindal, Robert E. Burke, Scotte R. Hartronft, Nicholas A. Rattray, Mathew J. Reeves, Joanne K. Daggy, Stanley E. Taylor, Greg Arling, Kimberly J. Waddell, Ashley L. Schwartzkopf, Jennifer L. Myers, Cathy C. SchubertAbstract
Background
Thirty‐day performance measures (e.g., unplanned readmissions), designed to evaluate inpatient care, were neither designed to reflect the experience of patients transitioning from hospital to home, nor the impact of transitional programs to improve postdischarge outcomes.
Objective
To identify transitional care outcomes by examining a range of postdischarge encounters and mortality.
Methods
This retrospective observational cohort (October 2022–September 2023) included community‐dwelling patients ≥65‐years‐old, discharged from 120 Department of Veterans Affairs (VA) hospitals to home after medical or neurological admissions. The outcomes, assessed 30‐ and 90‐days postdischarge were: mortality; planned and unplanned readmissions; observation stays; Emergency Department (ED) visits at VA or non‐VA hospitals; and number of days in acute care.
Results
Among 99,778 patients, 71.1% had no acute care utilization within 30 days postdischarge; 49.9% in 90 days. Unplanned readmissions occurred in 14.4% ( N = 14,400) at 30 days; 27.5% ( N = 27,386) at 90 days. Mortality occurred in 1.8% ( N = 1750) within 30 days; 5.6% ( N = 5624) within 90 days. Mortality was highest among patients with unplanned readmissions: 30 days, 6.1% (882/14,400); 90 days, 13.1% (3599/27,386). Planned readmission mortality rates were 30 days, 5.8% (59/1017); 90 days, 9.6% (258/2692). Half of patients who died within 30 days postdischarge did so after an unplanned readmission (50.4% [882/1750]); 35.0% (613/1750) had no acute care utilization. Among N = 94,154 patients who survived 90‐day postdischarge, 11.2% spent ≥10 days in acute care settings.
Conclusions
These findings support using the number of days in acute care within 90 days postdischarge as a transitional outcome. Thirty‐day readmissions do not capture the full scope of postdischarge healthcare utilization and mortality among community‐dwelling older adults.