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To the Editor Mr Nuti and colleagues reported that hospitalization at Veterans Affairs (VA) hospitals, compared with non-VA hospitals, was associated with lower 30-day all-cause mortality for older men with acute myocardial infarction or heart failure, but higher 30-day readmission rates for acute myocardial infarction, heart failure, or pneumonia.1 Our question focuses on the study’s method of risk adjustment—specifically, whether the authors’ method fully accounts for the burden of comorbid illness among veterans admitted to VA hospitals. It is unclear whether the authors incorporated both VA and Medicare claims, or Medicare claims alone, to identify comorbid conditions for veterans in their risk-adjustment models.
Radomski TR, Fine MJ, Gellad WF. Outcome After Admission at Veterans Affairs vs Non–Veterans Affairs Hospitals. JAMA. 2016;316(3):345-346. doi:10.1001/jama.2016.5391