The Department of Veterans Affairs healthcare system cut total hospital use in half and reduced admissions by one-third since 1995 while improving mortality among patients with several types of chronic diseases, according to a study in the New England Journal of Medicine. The VA reorganized in 1995 in an attempt to provide more comprehensive primary care and reduce hospitalization. Researchers theorized that any adverse consequences from the shift would show up first in people with serious chronic diseases. Urgent-care visits would increase or survival rates fall if reductions in hospital care were not offset by better ambulatory care. An examination of 342,000 patients with nine chronic conditions from 1994 through 1998 showed urgent-care visits fell 37% as use of outpatient services increased moderately. Survival rates for five of the conditions -- angina, bipolar disorder, depression, heart failure and pneumonia -- significantly improved and were unchanged for the remaining four.
During the same period, overall hospital use among U.S. men declined 15%, while admissions and lengths of stay dropped 4% and 11%, respectively. Declines in hospital stays for the VA patients were much sharper, ranging from 24% for kidney failure to 39% for depression. The decline in VA hospital use was not offset by proportional increases in the use of non-VA hospitals by veterans, researchers found. Read an abstract. -- by John Morrissey