More on Quality and Safety

Veterans' Affairs hospitals show quality equal to or greater than their private sector counterparts, data shows

The analysis found that VA hospitals were likely to provide the best care in a local healthcare market and rarely provided the worst care.

Jeff Lagasse, Associate Editor

Outcomes at VA hospitals are at least as good as those in the private sector, and in some cases are better, according to a new meta-analysis published in the Annals of Internal Medicine.

The Veterans Health Administration, VHA, is among the largest integrated healthcare systems in the United States, providing care at 1,243 healthcare facilities, including 172 VA Medical Centers and 1,062 outpatient sites.


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There are several circumstances that could account for the findings, the authors said. One is that the VHA may provide better care than the private sector in every local area.

Alternatively, non-VHA care may be better than VHA care in more local areas but by a small amount, whereas VHA care may be better than non-VHA care in fewer local areas but by a large amount in each area.

The average across all patients and hospitals would favor the VHA in the former circumstance and might favor the VHA in the latter.

The analysis identified 15 outcome measures that were reported by VHA and non-VHA hospitals by using data from Hospital Compare, a Centers for Medicaid and Medicare Services website which provides information on how well hospitals provide recommended care to their patients.

These measures included 30-day risk-adjusted mortality rates for four common diseases -- acute myocardial infarction, COPD, heart failure, and pneumonia -- plus 11 additional patient safety indicators.

They used each hospital's ZIP code to assign the hospital to one of 306 hospital referral regions -- limiting their analyses to the 121 regions in which at least one VHA and one non-VHA hospital reported at least one of the measures. (The Dartmouth Atlas of Health Care defines these regions as distinct healthcare markets.)

The researchers found that VA hospitals were likely to provide the best care in a local healthcare market and rarely provided the worst care in local markets.


However, the authors also raise the possibility that VA and non-VA hospitals may report data differently to Hospital Compare. If so, the authors recommend the VA and CMS take steps to adapt reporting methods to ensure fair comparisons by end users who are trying to make healthcare decisions.


Using a web-based report scorecard that measures, evaluates and benchmarks quality and efficiency at its medical centers, the U.S. Department of Veterans Affairs recently released data that seemed to indicate significant quality improvements at the majority of its healthcare facilities.

Compared with data from the same period a year ago, the July 2018 release of VA's Strategic Analytics for Improvement and Learning report showed 103 VA Medical Centers have improved in overall quality. That translates to about 71 percent of its total facilities.

The report didn't specify exactly what issues were occurring or steps that were taken to rectify them. But the VA has been moving lately to be more accomodating, finalizing its federal rule this year to allow providers to deliver patient care across state lines and outside of a VA facility using telemedicine.

Twitter: @JELagasse

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