July 18, 2016
The Veterans Affairs health care system generally performs better than or similar to other health care systems on providing safe and effective care to patients, according to a new RAND Corporation study.
Analyzing a decade of research that examined the VA health care system across a variety of quality dimensions, researchers found that the VA generally delivered care that was better or equal in quality to other health care systems, although there were some exceptions.
The RAND study found there was too little information related to timeliness, equity, efficiency and patient-centeredness to reliably draw conclusions about how the VA system compared to others across these dimensions. The findings are published in the Journal of General Internal Medicine.
“We found that the overall quality of care in the VA health system compares favorably to other segments of the U.S. health care system,” said Dr. Courtney Gidengil, co-author of the study and a physician scientist at RAND, a nonprofit research organization. “In some areas, the quality of care provided by the VA exceeded what we found in other settings, although there were areas where the quality of VA care fell short.”
The RAND study updates and expands a similar one conducted in 2009 and was a part of a large examination of the VA health care system conducted at the request of the U.S. Congress. The VA is the nation's largest integrated health care system.
RAND researchers searched the medical literature to identify research published between January 2005 and January 2015 about the quality of care at VA health facilities compared to non-VA health facilities. A total of 69 articles across dimensions including safety and effectiveness were found.
Twenty-two of the 34 studies on safety and 20 of the 24 studies focusing on effectiveness showed that the same, if not better, quality of care is provided in VA facilities. These studies took into account safety measures and best practices that aim to avoid the illness, injury or death of patients receiving care, such as complications after surgical procedures. Surgical patients in the VA system and VA nursing homes patients had death rates similar to patients in other health systems.
Rates of surgical complications and the availability of services had the least favorable results, but these results were mixed rather than consistently poor.
In terms of effectiveness, VA facilities had similar or superior quality to non-VA facilities with respect to preventive, recommended and end-of-life care, as well as managing medications. For example, outpatient care generally rated higher in VA facilities for diabetes care and screening tests related to heart disease and cancer.
Studies on the availability of services had mixed results. A comparison of studies from the earlier analysis and the new one from RAND showed that during the last five years, no stark trends can be observed about whether performance in the VA is better or worse than in other health settings.
Researchers say there were few studies done to evaluate equity, efficiency and patient-centeredness, and that the quality of the available studies vary.
While the studies included in the RAND analysis attempted to adjust for differences between veteran and nonveteran populations wherever possible, some differences between the two populations still may remain in the studies.
“Comparing the VA to other health care settings can be difficult because the VA has a patient population that is different from most other settings, with patients who may be sicker,” Gidengil said. “But it's important to do more of this work in the future so we can better understand the quality of care the VA provides.”
Support for the study was provided by the U.S. Department of Veterans Affairs. Other authors of the study are Claire O'Hanlon, Christina Huang, Elizabeth Sloss, Rebecca Anhang Price, Peter Hussey and Carrie Farmer.
The journal article provides an expanded discussion of findings from work RAND did as part of the VA Choice project, which was required by the Veterans Access Choice and Accountability Act. The legislation was in response to reports that veterans faced long delays for care at some VA health facilities. All of RAND's work from the project is at www.rand.org/health/projects/VA-choice.html.
RAND Health is the nation's largest independent health policy research program, with a broad research portfolio that focuses on population health, health care costs, quality and public health systems, among other topics.