Bottom Line: Costs and risk of death after coronary procedures differed for veterans who underwent coronary procedures at non-VA hospitals.
Why The Research Is Interesting: The VA Community Care Program allows veterans to seek care at non-VA hospitals and clinics if the VA cannot provide the needed care because of a lack of specialists, long wait times or extraordinary travel distances. The VA is considering expanding the program, so it is important to understand if outcomes, costs and measures justify veterans care in non-VA settings.
Who and When: Veterans undergoing elective coronary revascularization between 2008-2011: 13,237 veterans undergoing percutaneous coronary intervention (stent placement) and 5,818 veterans undergoing elective coronary artery bypass graft (CABG) surgery.
What (Study Measures): Elective coronary revascularization procedures at a VA hospital vs community-based facility (exposures); access to care measured by travel distance; 30-day mortality; and costs (outcomes).
How (Study Design): This is an observational study. Researchers were not intervening for purposes of the study and they cannot control natural differences that could explain study findings.
Authors: Paul G. Barnett, Ph.D., VA Palo Alto Health Care System, Menlo Park, California
Results: Almost 1 in 5 elective coronary revascularizations for VA patients was performed at community-based hospitals and outcomes varied by procedure and type of hospital. Death in this study group of veterans was rare so the ability to detect differences in the quality of care at VA and community-based hospitals may have been limited.
Study Limitations: Data included only procedures between 2008-2011 and patterns may have changed over time.
Study Conclusions: Undergoing elective coronary revascularization procedures at community-based hospitals was associated with shorter travel distances for veterans but other differences in outcomes and costs existed.
The following related elements also are available on the For The Media website:
- The editorial, "Coronary Revascularization for Veterans There's No Place Like Home," by Frederic S. Resnic, M.D., M.Sc., Lahey Hospital and Medical Center, Burlington. Massachusetts, and Gautam Gadey, M.D., Tufts School of Medicine, Boston.
For more details and to read the full study, please visit the For The Media website.
Editor's Note: Please see the article for additional information, including other authors, author contributions and affiliations, financial disclosures, funding and support, etc.
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