Research News

Evidence Synthesis Shows VA Performs Better than Non-VA Healthcare on Quality Measures for Processes of Care

October 27, 2010

A recent evidence synthesis led by Amal Trivedi, MD, MPH, part of HSR&D's Center on Systems, Outcomes and Quality in Chronic Disease & Rehabilitation, found that the VA healthcare system generally outperforms the private sector in following recommended processes of care for non-surgical healthcare. The results appeared the October 18 online edition of Medical Care.

In the 1990s, VA initiated a system-wide organizational transformation that focused on improving the quality of patient care. Since that time, peer-reviewed literature and the lay media have reported both favorable and unfavorable findings about VA's quality of care. Investigators sought to understand the totality of evidence by assessing 36 studies published between 1990 and August 2009. These studies were then used to assess different domains of quality, including: evidence-based processes of care, intermediate outcomes (e.g., control of blood pressure and cholesterol), and mortality.

Specific findings of the review include:

• Nine studies comparing VA and non-VA care showed, in general, a greater adherence to accepted processes of care—or better health outcomes—in VA.
• Three studies of care after a heart attack found greater rates of evidence-based drug therapy among VA patients. In addition, more VA patients than Medicare patients received beta-blockers (50% vs. 42%), angiotensin-converting-enzyme inhibitors (45% vs. 33%), or aspirin (77% vs. 69%) at discharge.
• Three studies of diabetes care found VA to have better adherence to guidelines. In one study, VA outperformed commercial managed care plans on all seven measures of care processes (e.g., hemoglobin and lipid testing, eye and foot exams).
• Three studies found higher rates of vaccination against flu and pneumonia for the elderly in VA.
• Most studies found statistically similar mortality rates between VA and non-VA care.

Investigators from the RAND Corporation, the University of California, Los Angeles, and the VA Greater Los Angeles Healthcare System collaborated with Dr. Trivedi on this evidence synthesis, which was funded through HSR&D's Evidence-based Synthesis Program. Dr. Trivedi is supported by an HSR&D Career Development Award