“Here at VA we’re trying to provide the best patient-centered care possible. We want to get you diagnosed. We want to get you treated. We want to get you home.” — Dr. Peter Kaboli, VA hospitalist
A shorter stay in the hospital can actually be more beneficial to you than a longer stay, according to a recent VA study that appeared in the December 18, 2012 issue of Annals of Internal Medicine.
“This study shows that a large health care system like VA can improve both quality and efficiency to provide better, more cost-effective care,” said Dr. Peter Kaboli, a hospitalist at the Iowa City VA Health Care System and the study’s lead researcher. “Ultimately the focus should not be how long a patient is in the hospital, but ensuring they get the care they need as efficiently as possible and get them out of the hospital as soon as they are ready.”
Kaboli and his research team came to this conclusion after examining the records of over four million Veterans hospitalized at 129 VA medical centers between 1997 and 2010.
“People come to the hospital for all kinds of medical conditions, so for our study we looked at everybody,” the researcher said. “But we also zeroed in on some of the more common health issues like heart failure and pneumonia.”
As the study progressed, an interesting pattern began to emerge: hospital stays at VA decreased by almost 30 percent over a period of about 14 years.
“We initially thought this might translate into higher readmission rates and death rates,” Kaboli said. “It turned out to be just the opposite: readmission rates went down by 16 percent. Death rates went down by three percent.”
“Creative research of this nature is a major factor leading to continuous improvement of the medical services we provide to our Nation’s Veterans.”
— Dr. Joel Kupersmith, VA Chief Research & Development Officer
The take-away from all this? “The individual needs to be in the hospital for as long as it takes to address their medical issues, and no longer,” Kaboli observed. “Everyone is different…one patient might be able to go home within 48 hours. Another patient might not be able to go home for five days.”
Kaboli said VA’s success in lowering readmission rates while simultaneously reducing hospital stays points to an increased level of efficiency. He attributes this increased efficiency to three big factors.
“First, throughout VA we’ve been working hard on improving the coordination that occurs between the hospital and our outpatient services,” he explained. “Successfully transitioning out of the hospital into outpatient care is so critical. The patient’s health and well-being depend on this transition being done correctly.
“Second,” he continued, “we’re working hard on constantly improving the quality of the care we provide. For example, care at VA is now delivered by Patient Aligned Care Teams — a team of specialists who coordinate closely with one another regarding the patient’s case. The patient is a big part of this team.”
The third big factor? Specialization.
“VA has adopted the use of hospitalists at over 80 percent of our medical centers,” Kaboli said. “Hospitalists are physicians who specialize in the care of hospitalized patients. Care delivered by hospitalists has been shown to be more efficient and can result in higher quality health care.”
Kaboli said quality health care occurs when everyone — the patient, the patient’s family, and hospital staff — are communicating with one another.
“In the end,” he said, “it’s all about listening to the patient so we can determine what their needs are, what their goals are. The patient needs to be at the center of the whole process.”