Leo Sher, M.D.

A RAND Corporation report, “Comparing quality of care in Veterans Affairs and non-Veterans Affairs settings” has been published in the Journal of General Internal Medicine (1). The Veterans Health Administration in the Department of Veterans Affairs (VA) is the largest integrated healthcare system in the United States. The goal of the study was to examine 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.

The authors examined quality measures related to inpatient and outpatient care, comparing VA and non-VA medical settings. For inpatient measures, the authors used propensity score matching to identify a subset of non-VA medical facilities with similar features to VA medical facilities. For outpatient measures, the authors compared VA facility performance rates to rates for health plans.

The study has shown that 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. The authors observed wide variation in performance across VA facilities for some measures and even wider variation across non-VA facilities. The smallest difference between the VA and commercial HMOs was in the rate of antidepressant medication management during acute phase, while the biggest difference was in the rate of eye examinations for individuals with diabetes. VA settings did better on both measures than non-VA settings. The authors suggest that there is a need for quality improvement to make sure that veterans receive consistently high quality care at all VA facilities.

Reference

1. Anhang Price R, Sloss EM, Cefalu M, Farmer CM, Hussey PS. Comparing quality of care in Veterans Affairs and non-Veterans Affairs settings. J Gen Intern Med. 2018 Apr 25. doi: 10.1007/s11606-018-4433-7. [Epub ahead of print]