1045. Is Better Quality in VHA Confined to Areas of Performance Measurement?
Steven M Asch, MD, MPH, VA Greater Los Angeles HSR&D Center of Excellence, EA Mcglynn, VA Greater Los Angeles HSR&D Center of Excellence, MM Hogan, VA Greater Los Angeles HSR&D Center of Excellence, RA Hayward, VA Greater Los Angeles HSR&D Center of Excellence, P Shekell, VA Greater Los Angeles HSR&D Center of Excellence, L Rubenstein, VA Greater Los Angeles HSR&D Center of Excellence, J Keesey, VA Greater Los Angeles HSR&D Center of Excellence, J Adams, VA Greater Los Angeles HSR&D Center of Excellence, EA Kerr, VA Greater Los Angeles HSR&D Center of Excellence

Objectives: During the last decade, the VHA introduced system wide quality monitoring. Previously we found that overall quality of care in the VHA was better than care in a community sample. In this study we examined whether differences in performance were confined to areas included in the VHA quality monitoring system.

Methods: We randomly sampled 596 men with at least 2 visits in each of 2 years in two VHA regions. Comparison cases included 992 males from 12 communities and this sample was reweighted to match the VHA sample. We measured quality using QATools, a chart-based instrument with 348 indicators for 26 conditions. Adjusting for age, number of conditions and outpatient visits, we examined the odds that VHA patients received more recommended care for indicators associated with VHA performance measures.

Results: VHA patients were more likely than community patients to receive care in the conditions or areas specified by the VHA indicator set (OR=2.04, 95% CI:1.86-2.24). Odds were greater for specific indicators closely matching the VHA performance measurement set (OR=2.74, 95% CI:2.42-3.10). Even for other indicators, VHA patients were still more likely to receive indicated care (OR=1.22, 95% CI:1.01-1.48).

Conclusions: Better quality of care for VHA patients was not confined to the small number of areas targeted for quality monitoring, though these areas showed the largest differences.

Impact: Future research will need to tease out the relative effects of performance measurement, the electronic medical record and other systemic quality improvement activities in explaining the superior performance of the VHA.