Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care
Comparing Postoperative Readmission Rates Between Veterans Receiving Total Knee Arthroplasty in the Veterans Health Administration Versus Community Care
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DOI：
10.1097/mlr.0000000000001678
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发表时间：
2022-02-01
期刊：
影响因子：
3
通讯作者：
Giori, Nicholas J.
中科院分区：
文献类型：
--
作者：
Rosen, Amy K.;Beilstein-Wedel, Erin E.;Giori, Nicholas J.
背景：人们越来越担心退伍军人在社区中更多地使用退伍军人健康管理局 (VA) 购买的护理可能会导致护理质量下降。目的：我们比较了在国家和机构层面上在 VA 进行或由 VA 通过社区护理 (CC) 购买的选择性全膝关节置换术 (TKA) 后的再入院率。方法：使用来自 VA 企业数据仓库的 VA 和 CC 管理数据（2016 年 10 月 1 日至 2019 年 9 月 30 日）进行三年队列研究。我们获取了 Medicare 数据，以了解由 Medicare 支付的再入院人数。我们使用医疗保险和医疗补助服务中心 (CMS) 的方法来识别计划外的 30 天全因再入院情况。次要结果是 TKA 相关的再入院，确定了因索引手术并发症导致的再入院。我们运行混合效应逻辑回归模型来比较 VA 与 CC 中进行的 TKA 之间全因和 TKA 相关再入院的风险调整几率，并根据患者的社会人口统计学和临床特征进行调整。主要发现：在全国范围内，VA 中进行的 TKA 与 CC 相比，发生全因或 TKA 相关再入院的几率明显较低（例如，VA 中发生全因再入院的几率是 CC 中的 35%。在机构层面，大多数 VA 机构的表现与其相应的 CC 提供者相似，尽管有 3 家 VA 机构的表现比相应的 CC 提供者差。结论：考虑到 VA 在为患者提供高质量外科护理方面的历史，对于退伍军人来说，密切监测和跟踪手术护理转向 CC 是否会随着时间的推移影响这两种环境的质量非常重要。
Background: There are growing concerns that Veterans' increased use of Veterans Health Administration (VA)-purchased care in the community may lead to lower quality of care. Objective: We compared rates of hospital readmissions following elective total knee arthroplasties (TKAs) that were either performed in VA or purchased by VA through community care (CC) at both the national and facility levels. Methods: Three-year cohort study using VA and CC administrative data from the VA's Corporate Data Warehouse (October 1, 2016-September 30, 2019). We obtained Medicare data to capture readmissions that were paid by Medicare. We used the Centers for Medicare and Medicaid Services (CMS) methods to identify unplanned, 30-day, all-cause readmissions. A secondary outcome, TKA-related readmissions, identified readmissions resulting from complications of the index surgery. We ran mixed-effects logistic regression models to compare the risk-adjusted odds of all-cause and TKA-related readmissions between TKAs performed in VA versus CC, adjusting for patients' sociodemographic and clinical characteristics. Principal Findings: Nationally, the odds of experiencing an all-cause or TKA-related readmission were significantly lower for TKAs performed in VA versus CC (eg, the odds of experiencing an all-cause readmission in VA were 35% of those in CC. At the facility level, most VA facilities performed similarly to their corresponding CC providers, although there were 3 VA facilities that performed worse than their corresponding CC providers. Conclusions: Given VA's history in providing high-quality surgical care to Veterans, it is important to closely monitor and track whether the shift to CC for surgical care will impact quality in both settings over time.