Jha A, Perlin J, Kizer KW, Dudley RA; AcademyHealth. Meeting (2003 : Nashville, Tenn.).

Abstr AcademyHealth Meet. 2003; 20: abstract no. 686.

Brigham and Women's Hospital, Division of General Medicine, Neville House 319, 75 Francis Street, Boston, MA 02115 Tel. (617)-732-5500 Fax (617) 732-7072

RESEARCH OBJECTIVE: In the mid-1990s, the Department of Veterans Affairs (VA) health care system launched a re-engineering effort to improve its quality of care, among other things. We sought to determine how the quality of care provided by VA after implementation of the major changes compared to Medicare fee-for-service (FFS). STUDY DESIGN: We used data from a series of cross-sectional samples to assess for preventive, acute and chronic care in VA and compared these with data from Medicare fee-for-service using quality indicators having similar data collection and sampling methods. Regional VA and Medicare performances were analyzed to assess geographical variability. POPULATION STUDIED: Patients were sampled during the years 1997 through 1999. VA data were obtained from the External Peer Review Program (EPRP)which sampled veterans visiting VA clinics. Medicare data were obtained from several published sources including patient surveys and chart review. VA data were restricted to patients over the age of 65 years to ensure comparability with the Medicare population. PRINCIPAL FINDINGS: We found nine quality indicators for which VA and Medicare utilize comparable data methods. When compared to Medicare fee-for-service, VA scores were significantly better for all nine quality indicators, and clinically far superior in eight of the nine. The smallest difference was in the rate of retinal exams among diabetics (absolute difference = 4%, p<0.001) and the largest difference was in the rate of mammography (absolute difference = 33%, p<0.001). For the eight quality indicators in which VA performed much better than Medicare, VA performance was superior in nearly all regions of the country. Rates of diabetic eye exams were similar for VA and Medicare across the United States. CONCLUSIONS: When standard quality of care indicators were compared for VA and Medicare FFS, VA's performance was substantially better nationally and within all U.S. regions. The findings were consistent across several venues of clinical care, including outpatient chronic care, inpatient acute care, and preventive care. IMPLICATIONS FOR POLICY, DELIVERY OR PRACTICE: VA's high quality of care across the clinical spectrum is likely due to implementation of systems changes, which included a redesign of the health delivery system to be safe, patient-centered, quality focused, effective, equitable and timely, using information management technology, performance measurement, reporting and accountability. VA's improved performance may provide insights for other organizations seeking to improve quality.

Publication Types:

• Meeting Abstracts

Keywords:

• Ambulatory Care
• Ambulatory Care Facilities
• Data Collection
• Fee-for-Service Plans
• Hospitalization
• Hospitals, Veterans
• Humans
• Medicare
• Quality Indicators, Health Care
• United States
• United States Department of Veterans Affairs
• Veterans
• economics
• hsrmtgs

Other ID:

• GWHSR0003977

UI: 102275656

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