Patients seen at Veterans Health Administration (VHA) clinics receive better overall quality of care, chronic disease care, and preventive care than those seen at other community sites. The VHA has championed a more coordinated system of care since the early 1990s, when they initiated a sophisticated electronic medical record system, measurement of performance on several quality measures, and a system-wide commitment to quality improvement, explains Elizabeth A. McGlynn, Ph.D., of RAND Health.
In a study that was supported in part by the Agency for Healthcare Research and Quality (HS09463), Dr. McGlynn and her colleagues compared the quality of care at 26 clinical sites in 12 VHA health systems with care received by a random sample of adult males older than 35 years of age in 12 communities between 1997 and 2000. The researchers used a chart-based quality instrument consisting of 348 quality of care indicators targeting 26 conditions ranging from asthma and urinary tract infection to diabetes, depression, and preventive care. After adjusting for clustering, patient age, number of visits, and medical conditions, VHA patients scored significantly higher than those at other sites for overall quality (67 vs. 51 percent), chronic disease care (72 vs. 59 percent), and preventive care (64 vs. 44 percent) but not for acute care.
The VHA advantage was most prominent in processes targeted by VHA performance measurement (66 vs. 43 percent) and least prominent in areas unrelated to VHA performance measurement (55 vs. 50 percent). To date, the VHA has not targeted acute care as part of its performance measurement system. These findings suggest that VHA performance measurement efforts are indeed contributing to better quality of care at VA clinics.
More details are in "Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample," by Steven M. Asch, M.D., M.P.H., Dr. McGlynn, Mary M. Hogan, Ph.D., and others, in the December 21, 2004, Annals of Internal Medicine 141(12), p. 938-945.
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