Summary

In response to a congressional request, GAO reviewed the Veterans Administration (VA) quality assurance systems and procedures for health care to determine: (1) the extent to which VA medical centers had implemented quality assurance programs; and (2) the roles of and processes used by other VA organizations in ensuring quality care.

GAO found that the 13 medical centers it reviewed had quality assurance plans and programs to: (1) establish policies regarding the provision of quality health care; (2) hire quality health care providers; and (3) identify and resolve health care problems. However, the medical centers did not systematically: (1) determine whether health care and services provided were appropriate to patient needs; (2) determine patterns and trends of health care provided; and (3) resolve systemic quality of care problems. Officials did not view such noncompliance as a problem, and GAO could not determine whether these failures resulted in poor quality care. Until March 3, 1985, the VA Medical Inspector conducted quality assurance programs and these programs will continue in the future under the Office of Quality Assurance. GAO also found that: (1) the reviews have not evaluated the effectiveness of the centers' quality assurance programs; (2) VA has not achieved it goal to conduct 60 reviews annually; (3) some reviewers believe that the timeframe for conducting reviews is too short; and (4) the Medical Inspector has conducted limited trend and data analyses and has not developed standards for use in the quality assurance program. The VA Inspector General oversees the Medical Inspector's investigation activities and conducts routine audits which address certain aspects of the quality assurance process such as assessing malpractice claims against VA.