Case study eligibility criteria
| Eligibility criteria | Process for establishing eligibility |
| Criteria 1. A minimum of 2000 admissions per year to the facility | After visually reviewing the all-cause medical surgical readmission rates for 2006–2011 for all VHA hospitals and comparing facilities with varying admission totals, we identified that facilities with >2000 admissions/year had less dramatic variability in their year-to-year readmissions rates. We also felt that facilities with larger numbers of admissions were more likely to spend intellectual and human resources on care transitions. |
| Criteria 2. Significantly increasing or decreasing all-cause medical surgical readmission rate between fiscal years 2006 and 2011 | Using the unadjusted readmission rates obtained from the IPEC readmission cube,46 we tested whether the change in rate over 5 years was significant or not. Eleven facilities were improvers (declining readmission rates), nine facilities had significantly worsening rates (increasing readmission rates) over that time. We chose facilities with significantly changing rates as we wanted to explore attempts at innovations and changes in the outcomes of interest to the facility. |
| Criteria 3. Two or more care transition innovations identified | Within the two different readmission performance groups (improving or worsening), we narrowed selection further using multiple sources of data regarding care transitions innovations within the VHA including a national survey of Utilization Management Nurses conducted in 2013, listings of all transitional care pilot projects funded by a VHA initiative called the Geriatrics T21 funds, and listings of all VHA Flow Improvement collaboratives on care transitions in the same time frame. We felt documented efforts to improve care transition processes provided evidence of some attempts at bettering readmission rates but did not expect that these would be the only care transition or rate improvement efforts undertaken by the sites. By comparing each of these sources for information, we identified 13 facilities, meeting the above criteria, with evidence of two or more innovations taking place around care transitions and prevention of readmissions. We eliminated from the potential sample pool the seven facilities for which we did not have evidence of two or more care transitions innovations. |
VHA, Veterans Health Administration.