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December 20, 2004
VA edge linked to improved information technology, tracking of performance, and accountability
Patients enrolled in the Department of Veterans Affairs (VA) health system are significantly more likely than similar patients in the general population to receive preventive and chronic care recommended by well-established national standards, according to a new study released today in the Annals of Internal Medicine.
Researchers with VA; the RAND Corporation; the University of California, Los Angeles; and the University of Michigan compared the medical records of VA and non-VA patients and evaluated how effectively health care is delivered for acute, chronic and preventive care for 26 medical conditions.
The study found that:
- Overall, VA patients received 67 percent of recommended care compared with 51 percent in the national sample.
- Performance in the VA health system outpaced the national sample for chronic care; 72 percent of indicated chronic care was delivered to VA patients compared with 59 percent in the national sample.
- Quality of preventive care, such as pneumococcal vaccination and screening for colorectal cancer, showed even greater differences; 64 percent of indicated preventive care was delivered to VA patients compared with 44 percent in the national sample.
- Generally, VA patients received consistently better care across the entire spectrum of care, including screening, diagnosis, treatment and follow-up.
- Quality of care for acute conditions was similar across both study populations.
The study compared the quality of outpatient and inpatient care between a national sample of patients drawn from 12 communities representative of metropolitan areas with populations of 200,000 or more and a sample of VA patients from 26 facilities in 12 health care systems located in the Southwestern and Midwestern United States. It assessed 348 clinical indicators of quality for the 26 acute and chronic conditions such as urinary tract infections, diabetes, asthma, high blood pressure and heart disease — along with preventive care.
“These findings are important because they show it is possible to improve the care patients receive,” said lead study author Steven M. Asch, M.D., M.P.H.; Veterans Affairs Greater Los Angeles Health Care System; the University of California, Los Angeles and RAND. “It challenges all of us to consider how the methods that the VA is using to improve care could be used to raise the bar in other healthcare settings.”
The study found that the differences between VA and the national sample were greatest where the VA has established performance measures and actively monitored performance. When assessing those specific indicators, VA patients had a substantially greater chance of receiving the indicated care than did the patients in the national sample (67 percent vs. 43 percent).
“We found that the differences in quality of care were much greater in areas where VA is measuring its performance,” said Eve A. Kerr, MD, MPH, study co-author from Veterans Affairs Ann Arbor Healthcare System and the University of Michigan Medical School. “This is strong evidence that if you measure the standards of care, then the quality of care will improve.”
In addition to using a sophisticated electronic medical record system, the VA uses a quality measurement approach that holds regional managers accountable for several processes in preventive care and in the management of common chronic conditions.
Acting VA Under Secretary for Health Jonathan B. Perlin, MD, PhD, MSHA, FACP, said: “This study confirms that using electronic medical records as well as setting and meeting high quality of care standards, especially in the areas of chronic and preventive care, are crucial to assuring that veterans receive improved health care.”
For almost all conditions assessed, VA patients fared better than the national sample. Among the findings:
- Depressed patients in the VA received 80 percent of indicated care compared with 62 percent in the national sample.
- Similarly, for diabetes care, the VA sample fared much better — 70 percent of indicated care was delivered compared with 57 percent in the national sample.
- There were a few conditions where there was little difference between the two samples. For example, 73 percent of indicated care for coronary artery disease was delivered to the VA sample compared with 70 percent in the national sample.
“The Veterans Health Administration is making significant strides in implementing technologies and systems to provide better care, but nationwide, too many patients are still not receiving indicated care for common conditions,” said Elizabeth McGlynn, Ph.D, associate director, RAND Health, and a co-author of the study. “Although VA patients received higher quality care, there is room for improvement both in and out the of the VA.”
The study was funded by the Veterans Affairs Health Services Research and Development Service, The Robert Wood Johnson Foundation, the Centers for Medicare and Medicaid Services, the Agency for Healthcare Research and Quality, and the California HealthCare Foundation.
Collaborating on the study were: Asch; McGlynn; Kerr; Mary Hogan, Ph.D. (VA Ann Arbor Healthcare System); Rodney Hayward, MD (VA Ann Arbor Healthcare System and University of Michigan); Paul Shekelle, MD, MPH (VA Greater Los Angeles Health Care System, RAND, University of California, Los Angeles); Lisa Rubenstein, MD (VA Greater Los Angeles Health Care System, RAND, University of California, Los Angeles); Joan Keesey, B.A. (RAND); and John Adams, Ph.D. (RAND).
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The Department of Veterans Affairs (VA) provides health care services, medical research, benefits programs and memorial affairs for the nation's 26 million veterans.
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