Abstract
Objectives Understanding the prevalence and outcomes of cardiovascular disease across different health systems will enable organizations to effectively use clinical datasets to monitor and improve the care delivered to their patients. Framed within the context of comparative effectiveness research, this study utilized comprehensive administrative datasets to describe outcomes of hospital readmission, Emergency Department (ED) use, and mortality following a cardiovascular event (myocardial infarct, congestive heart failure, angina, stroke). We examined patients within the same geographic region (central Texas) at Scott & White Healthcare (SWHP) and the Veterans Health Administration (VA).
Methods Patients with a recorded cardiovascular event in 2009 were identified by ICD9 codes from the Virtual Data Warehouse (VDW) for SWHP patients and VA databases for veterans. Subsequent hospital readmission for any reason, 30-day mortality (all cause), and ED use were defined by dates of care, treatment location, and death data maintained by both systems. Covariates included age, gender, poverty status (non-payment for SWHP, high priority veterans), prior-year history of cardiac event, and Charlson comorbidity score.
Results Excluding 7 pediatric cases, 1,156 SWHP patients met inclusion criteria versus 406 VA cardiovascular event patients. Veterans were predominantly male (96%), aged 68.6 years (+/−11.2), of whom 14% died as inpatients. SWHP patients averaged 71.9 years (+/−14.6), with slightly over half being female. In addition to gender, VA patients also experienced greater overall comorbidity scores. Unadjusted models indicated that mortality and readmission rates were lower for SWHP patients relative to veterans; documented ED use was minimal in both systems. Ongoing analyses will examine specific gender and other patient characteristic differences by event type and clinical outcome.
Conclusions In the same geographic region, these comparative analyses were enabled by Scott & White’s participation in the VDW coupled with access to VA national administrative databases. While the two populations have well-recognized demographic and clinical differences (e.g., SWHP pediatric patients with their unique pathology, VA military service conditions), the similar richness of diagnosis codes, treatment dates, and healthcare-related outcomes will permit sophisticated adjusted analyses. Findings highlight VDW research benefits and the potential for dual system analysis, increasing priorities for these large health organizations.
