# Risk of Hospital Readmissions and Association With Receipt of Post‐Hospitalization Care Coordination Services Among High‐Risk Veterans

## TL;DR

This study found that post-hospital care coordination did not significantly reduce readmission rates among high-risk Veterans, suggesting the need for better interventions.

## Contribution

The study provides new evidence on the limited impact of post-hospital care coordination on reducing readmissions in high-risk Veterans.

## Key findings

- Post-hospital care coordination was not associated with a significant reduction in 30-day all-cause readmissions.
- There was no significant difference in ambulatory care sensitive condition readmissions between groups.
- Alternative or additional services may be needed to address readmissions in high-risk Veterans.

## Abstract

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.

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 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.

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).

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.