Abstract
OBJECTIVE: To examine associations between receipt of post-hospitalization care coordination and VA-delivered, VA-purchased, and Medicare fee-for-service hospital readmissions among Veterans at high risk for hospitalization and/or mortality. STUDY SETTING AND DESIGN: In this observational retrospective cohort study, we compared high-risk Veterans who received care coordination within one day after hospital discharge ("treated") with up to five matched high-risk Veterans who did not receive care coordination during this time ("comparators"). Competing risk models estimated adjusted sub-hazard ratios (aSHR) for 30-day all-cause and ambulatory care sensitive condition (ACSC) readmissions between treated and comparators, with death as a competing risk. In sensitivity analyses, we implemented inverse probability of censoring weights to account for censoring due to cross-over to treatment among comparators during follow-up. DATA SOURCES AND ANALYTIC SAMPLE: Data sources included the VA Vital Status File, VA Corporate Data Warehouse, and Centers for Medicare and Medicaid Services administrative files. Participants included 31,614 treated and 99,634 comparator high-risk Veterans initially hospitalized in fiscal year 2021. PRINCIPAL FINDINGS: Participants were primarily male sex, ≥ 65 years of age, and had initial hospitalizations in VA facilities; 15.9% and 2.3% of treated Veterans had 30-day all-cause and ACSC readmissions, respectively, compared with 13.5% and 2.1% of comparators. After accounting for the competing risk of death and covariates that remained imbalanced across groups after matching, post-hospitalization care coordination was associated with no difference in the risk of 30-day all-cause (aSHR 1.03, 95% CI 1.00, 1.07) and ACSC (aSHR 0.97, 95% CI 0.89, 1.05) readmission among high-risk Veterans. The risk of ACSC readmission was similar after including censoring weights (aSHR 1.00, 95% CI 0.92, 1.09); the increased risk of all-cause readmission was small in magnitude but statistically significant (aSHR 1.09, 95% CI 1.05, 1.13). CONCLUSIONS: Receipt of post-hospitalization care coordination was largely associated with no difference in 30-day readmission risk, suggesting that alternative or additional services may be needed to address readmissions among high-risk Veterans.