Comparing Quality of Care in Veterans Affairs and Non-Veterans Affairs Settings
Congress, veterans’ groups, and the press have expressed concerns that access to care and quality of care in Department of Veterans Affairs (VA) settings are inferior to access and quality in non-VA settings.
To assess quality of outpatient and inpatient care in VA at the national level and facility level and to compare performance between VA and non-VA settings using recent performance measure data.
We assessed Patient Safety Indicators (PSIs), 30-day risk-standardized mortality and readmission measures, and ORYX measures for inpatient safety and effectiveness; Healthcare Effectiveness Data and Information Set (HEDIS®) measures for outpatient effectiveness; and Consumer Assessment of Healthcare Providers and Systems Hospital Survey (HCAHPS) and Survey of Healthcare Experiences of Patients (SHEP) survey measures for inpatient patient-centeredness. For inpatient care, we used propensity score matching to identify a subset of non-VA hospitals that were comparable to VA hospitals.
VA hospitals performed on average the same as or significantly better than non-VA hospitals on all six measures of inpatient safety, all three inpatient mortality measures, and 12 inpatient effectiveness measures, but significantly worse than non-VA hospitals on three readmission measures and two effectiveness measures. The performance of VA facilities was significantly better than commercial HMOs and Medicaid HMOs for all 16 outpatient effectiveness measures and for Medicare HMOs, it was significantly better for 14 measures and did not differ for two measures. High variation across VA facilities in the performance of some quality measures was observed, although variation was even greater among non-VA facilities.
The VA system performed similarly or better than the non-VA system on most of the nationally recognized measures of inpatient and outpatient care quality, but high variation across VA facilities indicates a need for targeted quality improvement.
KEY WORDSveterans Veterans Affairs Veterans Health Administration quality
The authors gratefully acknowledge Marc N. Elliott for his statistical consultation, Chris Chan and Mike Cui for their programming support, Zachary Predmore and Clare Stevens for their research assistance, and Susan Hosek, Terri Tanielian, and Robin Weinick for their managerial support and guidance.
This work was completed under a subcontract from The MITRE Corporation for the U.S. Department of Veterans Affairs at the request of the Veterans Access, Choice, and Accountability Act of 2014 Section 201. The report was prepared under Prime Contract No. HHS-M500-2012-00008I, Prime Task Order No. VA118A14F0373.
Role of the Sponsor
The funding organization had no role in the design or conduct of the study; the collection, analysis, or interpretation of the data; or the preparation or approval of the manuscript. VA had the opportunity to review the manuscript before submission, but submission for publication was not subject to VA approval.
The analyses upon which this publication is based were performed under a contract for the Department of Veterans Affairs. The content of this publication does not necessarily reflect the views or policies of the Department of Veterans Affairs nor does the mention of trade names, commercial products, or organizations imply endorsement by the U.S. Government. The authors assume full responsibility for the accuracy and completeness of the ideas presented.
Drs. Anhang Price and Sloss had full access to all of the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.
Study concept and design; drafting of the manuscript: RAP, ES.
Acquisition of data; analysis and interpretation of data: RAP, ES, CC, MC.
Critical revision of the manuscript for important intellectual content: RAP, ES, PH, CF.
Administrative, technical, or material support: PH, CF.
Study supervision: RAP, ES, PH, CF.
Compliance with Ethical Standards
Conflict of Interest
The authors declare that they do not have a conflict of interest.
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