Evaluation of Changes in Veterans Affairs Medical Centers’ Mortality Rates After Risk Adjustment for Socioeconomic Status

Abstract

IMPORTANCESocioeconomic factors are associated with worse outcomes after hospitalization, but neither the Centers for Medicare & Medicaid Services (CMS) nor the Veterans Affairs (VA) health care system adjust for socioeconomic factors in profiling hospital mortality. OBJECTIVE To evaluate changes in Veterans Affairs medical centers' (VAMCs') risk-standardized mortality rates among veterans hospitalized for heart failure and pneumonia after adjusting for socioeconomic factors. DESIGN, SETTING, AND PARTICIPANTS In this cross-sectional study, retrospective data were used to assess 131 VAMCs' risk-standardized 30-day mortality rates with or without adjustment for socioeconomic covariates. The study population included 42 892 veterans hospitalized with heart

Development and Validation of a Clinical Risk Score to Predict Hospitalization Within 30 Days of Coronavirus Disease 2019 Diagnosis

“…The VHA priority group served as an indirect proxy for socioeconomic status as it takes into consideration patients’ income, financial security, Medicaid eligibility, receipt of VHA assistance benefits (e.g., pension, assisted-living, and Adult Day Care), and capacity for gainful employment. 24–26 It also accounts for health-related factors including severity of service-connected disabilities, and environmental and/or other exposures. 24–26 Priority group ratings range from 1 to 8, with lower ratings assigned higher priority by the VHA.…”

“… 24–26 It also accounts for health-related factors including severity of service-connected disabilities, and environmental and/or other exposures. 24–26 Priority group ratings range from 1 to 8, with lower ratings assigned higher priority by the VHA. Priority groups 1-4 include patients with service-connected disabilities rated between 10% and 100%, those who are unemployable as a result of service-related injury, those with a recognized status (e.g., Purple Heart recipient), and/or those who receive pension and/or other assistance benefits from the VHA.…”

“…Priority groups 1-4 include patients with service-connected disabilities rated between 10% and 100%, those who are unemployable as a result of service-related injury, those with a recognized status (e.g., Purple Heart recipient), and/or those who receive pension and/or other assistance benefits from the VHA. 24–26 Priority groups 5-6 include patients with service-connected disabilities rated as 0%, those eligible for Medicaid, and/or those with an annual income below the VHA national income threshold. 24–26 Priority groups 7-8 include patients with an annual income above the VHA national income threshold who agree to pay copayments.…”

“… 24–26 Priority groups 5-6 include patients with service-connected disabilities rated as 0%, those eligible for Medicaid, and/or those with an annual income below the VHA national income threshold. 24–26 Priority groups 7-8 include patients with an annual income above the VHA national income threshold who agree to pay copayments. 24–26 We examined patients’ smoking status and housing status (i.e., homeless, nursing home/long-term care residence, or other housing type) within 2 years before and including the index date.…”

“… 24–26 Priority groups 7-8 include patients with an annual income above the VHA national income threshold who agree to pay copayments. 24–26 We examined patients’ smoking status and housing status (i.e., homeless, nursing home/long-term care residence, or other housing type) within 2 years before and including the index date. The “other housing type” group included patients that did not have any record of homelessness or long-term care residence during that time.…”