Open AccessMortality and Length of Stay in a Veterans Administration Hospital and Private Sector Hospitals Serving a Common Market
Author(s) -
Rosenthal Gary E.,
Sarrazin Mary Vaughan,
Harper Dwain L.,
Fuehrer Susan M.
Publication year - 2003
Publication title -
journal of general internal medicine
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.746
H-Index - 180
eISSN - 1525-1497
pISSN - 0884-8734
DOI - 10.1046/j.1525-1497.2003.11209.x
Subject(s) - medicine , odds ratio , veterans affairs , confidence interval , retrospective cohort study , odds , logistic regression , private sector , emergency medicine , economics , economic growth
OBJECTIVE: To compare severity‐adjusted in‐hospital mortality and length of stay (LOS) in a Veterans Administration (VA) hospital and private sector hospitals serving the same health care market. DESIGN: Retrospective cohort study. SETTING: A large VA hospital and 27 private sector hospitals in the same metropolitan area. PATIENTS: Consecutive VA ( N = 1,960) and private sector ( N = 157,147) admissions in 1994 to 1995 with 9 high‐volume diagnoses. MEASUREMENTS: Severity of illness was measured using validated multivariable models that were based on data abstracted from medical records. Outcomes were adjusted for severity and compared in VA and private sector patients using multiple logistic or linear regression analysis. MAIN RESULTS: Unadjusted mortality was similar in VA and private sector patients (5.0% vs 5.6%, respectively; P = .26), although mean LOS was longer in VA patients (12.7 vs 7.0 days; P < .001). Adjusting for severity, the odds of death in VA patients was similar (odds ratio [OR] 1.07; 95% confidence interval [95% CI], 0.74 to 1.54; P = .73). However, a larger proportion of deaths in VA patients occurred later during hospitalization ( P < .001), and the odds of death in VA patients were actually lower ( P < .05) in analyses limited to deaths during the first 7 (OR, 0.56) or 14 (OR, 0.63) days. Adjusted LOS was longer ( P < .001) in VA patients for all 9 diagnoses. CONCLUSIONS: If the current findings generalizable to other markets, hospital mortality, a widely used performance measure, may be similar or lower in VA and private sector hospitals serving the same markets. The longer LOS of VA patients may reflect differences in practice patterns and may be an important source of bias in comparisons of VA and private sector hospitals.