The Quality of Health Care for Veterans Compared with Other Patients

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The summary below is from the full report titled "Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample." It is in the 21 December 2004 issue of Annals of Internal Medicine (volume 141, pages 938-945). The authors are S.M. Asch, E.A. McGlynn, M.M. Hogan, R.A. Hayward, P. Shekelle, L. Rubenstein, J. Keesey, J. Adams, and E.A. Kerr.

What is the problem and what is known about it so far?

The U.S. Veterans Health Administration (VHA) provides comprehensive health care to veterans through VHA-run medical centers. Previously, some have been concerned that the quality of care in VHA centers might not be as high as in other settings. Since the early 1990s, the VHA has worked to improve the quality of the health care it delivers. An important part of that effort has been a program that measures health care quality and holds administrators of VHA medical centers responsible for maintaining high-quality care at their institutions. Recent studies suggest that, in the areas where the VHA measures quality, care in the VHA system is better than it is in other health systems. It is unknown whether quality is better in the many other areas for which the VHA does not follow quality measures.

Why did the researchers do this particular study?

To compare the overall quality of health care in the VHA system, including areas the VHA does not routinely monitor for quality, with that of other health systems.

Who was studied?

596 patients from 26 VHA sites in the midwestern and southwestern United States and 992 patients seen at private hospitals and clinics in 12 large cities throughout the United States. All were men older than age 35 years.

How was the study done?

The researchers reviewed medical records and categorized each patient as having received or not received quality health care using 348 measures of high-quality care for 26 medical conditions. An example of a quality measure would be whether diabetic patients received appropriate tests of sugar control. The researchers then compared those measures in the VHA with those in other health systems.

What did the researchers find?

Overall, VHA patients received better care than patients in other settings. The differences in quality were largest in the areas where the VHA routinely monitors quality and smallest in the areas where it does not.

What are the limitations of the study?

The study did not include any women or men younger than age 35 years. Only some VHA and non-VHA settings were studied. The results may not apply to other types of patients or other settings. It is possible that VHA patients and non-VHA patients received similar care but that the electronic medical record in the VHA system made it easier to document high-quality care.

What are the implications of the study?

Patients cared for in the VHA health system seem to receive higher-quality care than patients who receive care elsewhere. The difference was greatest in health care areas that the VHA measures for quality, suggesting that measuring quality and holding administrators responsible for maintaining high measures may be a strategy that works to improve the quality of health care.