A RAND study found the VA health system performed as well or significantly better than non-VA hospitals on key measures for inpatient and outpatient safety and care effectiveness.
Despite its many, well-publicized problems, the VA delivers as good or better healthcare than non-VA systems on most measures of inpatient and outpatient care quality, albeit with wide variations across individual VA hospitals, a RAND Corporation study says.
Researchers examined common healthcare quality measures and found that VA hospitals generally provided better quality care than non-VA hospitals and the VA's outpatient services were better quality when compared to commercial HMOs, Medicaid HMOs and Medicare HMOs.
"Consistent with previous studies, our analysis found that the VA healthcare system generally provides care that is higher in quality than what is offered elsewhere in communities across the nation," said study lead author Rebecca Anhang Price, a senior policy researcher at RAND.
The study found wide variation in the quality of care provided in VA hospitals, but the variation is smaller than what researchers observed among non-VA hospitals.
For each of the VA's 135 hospitals, RAND identified three non-VA hospitals that had similar characteristics, such as geographic location. The performance of VA hospitals was compared to similar non-VA hospitals, as well as health systems overall.
The information analyzed includes the Healthcare Effectiveness Data and Information Set, and the Survey of Healthcare Experiences of Veterans.
The study found that:
- VA hospitals performed the same or better than non-VA hospitals on all six measures of inpatient safety, all three measures of inpatient mortality and 12 measures of the effectiveness of inpatient care.
- VA hospitals performed worse on three readmission measures and two effectiveness measures.
- VA inpatient performance was lower on the patient experience measure for pain management, while performance of VA hospitals was higher on patient experiences for management of care transitions.
- VA hospitals outperformed commercial HMOs and Medicaid HMOs for all 16 measures of the effectiveness of outpatient care. The VA outperformed Medicare HMOs on 14 of the 16 measures of effectiveness.
- The smallest difference between the VA and commercial HMOs was in the rate of antidepressant medication management during the acute phase. The largest difference was in the rate of eye examinations for patients with diabetes.
- The smallest difference between the VA and Medicaid HMOs was in the rate of ongoing beta-blocker treatment after an acute heart attack. The largest difference was in the rate of eye examinations for patients with diabetes.
The variation between individual VA facilities was large on some of the quality measures. For example, there was a 50 percentage point difference in performance between the lowest and highest performing VA facilities during 2014 on the rate of beta blocker treatment for at least six months after discharge for an acute heart attack.
RAND said some of the variation could be attributed to a sicker, older patient demographic at some VA hospitals. However, they said the findings show the VA needs targeted quality improvement efforts to ensure that veterans receive uniformly high-quality care.
The Veterans Health Administration, which operates the nation’s largest integrated health system, has been the subject of ongoing public scrutiny and criticism for a series of scandals involving care backlogs, mismanagement, and uneven leadership at the top.
The RAND study relies upon data and surveys complied in 2013 and 2014, when the VA was embroiled in a scandal over a care backlog and cover up at several of its hospitals across the nation.
Last month, the Trump administration fired VA Secretary David Shulkin, MD, an Obama administration holdover, amid allegations of ethical lapses, and a move by conservatives in Congress to press for more privatization of the VA.
This morning, Rear Adm. Ronny Jackson, MD, President Trump's personal physician and the administration's nominee to replace Shulkin, withdrew his nomination after more than 20 former colleagues accused him of drunkenness on the job, careless dispensing of prescription drugs, including opiates, and creating a toxic work environment.
In his withdrawal letter, Jackson called the allegations "completely false and fabricated."
John Commins is the news editor for HealthLeaders.