Journal of General Internal Medicine

, Volume 32, Issue 1, pp 105–121

Comparing VA and Non-VA Quality of Care: A Systematic Review

  • Claire O’Hanlon
  • Christina Huang
  • Elizabeth Sloss
  • Rebecca Anhang Price
  • Peter Hussey
  • Carrie Farmer
  • Courtney Gidengil
Review Paper

DOI: 10.1007/s11606-016-3775-2

Cite this article as:
O’Hanlon, C., Huang, C., Sloss, E. et al. J GEN INTERN MED (2017) 32: 105. doi:10.1007/s11606-016-3775-2

Abstract

Background

The Veterans Affairs (VA) health care system aims to provide high-quality medical care to veterans in the USA, but the quality of VA care has recently drawn the concern of Congress. The objective of this study was to systematically review published evidence examining the quality of care provided at VA health care facilities compared to quality of care in other facilities and systems.

Methods

Building on the search strategy and results of a prior systematic review, we searched MEDLINE (from January 1, 2005, to January 1, 2015) to identify relevant articles on the quality of care at VA facilities compared to non-VA facilities. Articles from the prior systematic review published from 2005 and onward were also included and re-abstracted. Studies were classified, analyzed, and summarized by the Institute of Medicine’s quality dimensions.

Results

Sixty-nine articles were identified (including 31 articles from the prior systematic review and 38 new articles) that address one or more Institute of Medicine quality dimensions: safety (34 articles), effectiveness (24 articles), efficiency (9 articles), patient-centeredness (5 articles), equity (4 articles), and timeliness (1 article). Studies of safety and effectiveness indicated generally better or equal performance, with some exceptions. Too few articles related to timeliness, equity, efficiency, and patient-centeredness were found from which to reliably draw conclusions about VA care related to these dimensions.

Discussion

The VA often (but not always) performs better than or similarly to other systems of care with regard to the safety and effectiveness of care. Additional studies of quality of care in the VA are needed on all aspects of quality, but particularly with regard to timeliness, equity, efficiency, and patient-centeredness.

KEY WORDS

veterans Veterans Affairs Veterans Health Administration quality systematic review 

Supplementary material

11606_2016_3775_MOESM1_ESM.docx (85 kb)
ESM 1(DOCX 85 kb)

Copyright information

© Society of General Internal Medicine 2016

Authors and Affiliations

  • Claire O’Hanlon
    • 1
    • 2
  • Christina Huang
    • 1
    • 2
  • Elizabeth Sloss
    • 3
  • Rebecca Anhang Price
    • 3
  • Peter Hussey
    • 4
  • Carrie Farmer
    • 5
  • Courtney Gidengil
    • 4
  1. 1.Pardee RAND Graduate SchoolSanta MonicaUSA
  2. 2.RAND Corp.Santa MonicaUSA
  3. 3.RAND Corp.ArlingtonUSA
  4. 4.RAND Corp.BostonUSA
  5. 5.RAND Corp.PittsburghUSA

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