WASHINGTON -- The quality of health care veterans receive from the Department of Veterans Affairs (VA) has improved significantly, according to a VA study published in the New England Journal of Medicine recently. A major overhaul of the health care system that began in 1995 led to improvements in quality indicators.
"VA is the benchmark in quality for many areas of health care -- patient safety, computerized patient records, bar-coding," said Secretary of Veterans Affairs Anthony J. Principi. "Now this study demonstrates how VA’s performance measurements, accountability and incentives for improvement led to more rapid rates of improvement."
Researchers for the study were from VA, Brigham and Women’s Hospital, the National Quality Forum and the University of California. Using data from VA’s External Peer Review Program, researchers compared quality indicators of preventive, acute and chronic care with similar data from the Medicare fee-for-service program.
To assess performance on an ongoing basis, clinical managers were provided data from VA's External Peer Review Program. The current study represented all VA locations nationwide and included between 50,000 and 90,000 individual medical records each year since 1995.
Reviewers gathered data on standard quality of care indicators, including those for preventive care, such as the frequency of mammography, vaccination and colorectal cancer screening. The data also included markers for quality outpatient care: reaching target blood pressure readings for patients with hypertension, prescription of aspirin within 24 hours of a myocardial infarction (heart attack), cholesterol screening and control for diabetes and heart disease patients and appropriate preventive services like vaccinations and screenings for other patients.
Researchers found significant improvement for all quality-of-care indicators measured by VA between 1994 and 2000. They also found VA outperformed Medicare on all 11 markers the two systems had in common between 1997 and 1999, and on 12 of 13 indicators measured between 2000 and 2001.
"By 1997, nearly all the quality markers had significantly improved compared to what they were in 1995, and they continued to improve every year through 2000," said Dr. Jonathan B. Perlin, VA’s deputy under secretary for health.
The study also compared the quality of care in the VA health system with Medicare fee-for-service care. "For all measures that the two systems had in common, VA performed better and improved faster than Medicare," said Perlin.
In 2002, the Institute of Medicine recognized VA for implementing the kind of changes it had recommended the previous year to improve the quality of health care in America.
"These findings show the amount of improvement that’s possible when managers are accountable for improving quality as well as the reliability of computerized information about their progress in achieving that goal," Principi said.
"Performance measurement is critical for rapid improvement," said Perlin. "We measure to define where we’ll be, not to record where we’ve been."
