Abstract 318: Distance From Percutaneous Coronary Intervention Site is Not Associated with 30-day Readmission Length of Stay: Insights From the Veterans Affairs Clinical Assessment, Reporting and Tracking (VA CART) Program

Background: Although readmission following PCI is an emerging quality measure, it is unclear to what extent readmissions post-PCI are avoidable. Many VA patients travel long distances to receive PCI, and a prior study suggests that those living closest to their PCI site are most likely to be readmitted. Using length of stay (LOS) as a proxy for readmission complexity, we explored whether this lower readmission rate reflects a higher threshold for readmission among patients living farther away from PCI sites. Methods: We identified all VA patients undergoing PCI from 2008-2012, excluding those with private insurance or non-VA sources of care to minimize the likelihood of readmissions outside of VA hospitals. Distance to PCI site was determined by straight-line distance (SLD) from patient residence to the site. The primary exposure was quintile SLD to PCI site. We compared risk-adjusted post-PCI readmission mean LOS by quintile, as well as the trimmed mean (excluding the top 5% LOS per quintile) to minimize outlier effects. We also grouped readmission diagnoses into 8 categories (cardiac ischemic, cardiac-nonischemic, peripheral/cerebrovascular ischemia, procedural, bleeding/anemia, respiratory, renal, and other), comparing diagnoses by SLD quintile. Results: Among 38,937 patients undergoing PCI, the median SLD to PCI site was 37 mi., IQR 12-85. Crude readmission rates ranged from 16.5% (Q1: 0-9 miles) to 10.2% (Q5: 99-300 mi.). Compared to Q1, the relative difference in mean LOS was significantly lower in Q3 (Q3: 0.77, p = 0.03) and unchanged in all other quintiles (Q2: 0.95, p=0.75; Q4: 0.79, p=0.07; Q5: 0.92, p=0.56; Table). Comparing trimmed means, no quintile was significantly different from Q1. Diagnosis review found higher rates of cardiac ischemia diagnoses in higher SLD quintiles without other clinically significant differences in diagnoses by SLD. Conclusions: We did not find an association between patient distance to PCI site and LOS for post-PCI readmissions, and readmission diagnoses were overall similar across quintiles. Thus, post-PCI readmissions across quintiles are likely of similar complexity and for similar diagnoses. Identifying other possible contributors to differences in readmission rates by distance may have important implications for policy and resource allocation. ![][1] [1]: /embed/graphic-1.gif