Are We as Good as We Hope? Using comparative data to evaluate quality at VA and non-VA facilities

Session number: 1051

Abstract title: Are We as Good as We Hope? Using comparative data to evaluate quality at VA and non-VA facilities

Author(s):
JW Peabody - SFVAMC
J Luck - WLAVA
Joyce Hansen - CPMC
Chris Conti - WLAVA

Objectives: In the past, the quality of VA care has been questioned and one oft-heard opinion is that VA care has not been of the same quality as that provided in non-VA facilities. These reports have at best been taken out of context and at worse are unsubstantiated by careful analysis. We therefore evaluated the quality of outpatient care at VA and non-VA sites for common outpatient condition, using methods that were fully comparable across sites.

Methods: We prospectively measured the quality of care using two methods—standardized patients (SPs) and computerized clinical vignettes—of 60 randomly selected doctors in two VA and two non-VA facilities. We measured the quality of care for (4) conditions: COPD, diabetes, vascular disease and depression; each condition was evaluated using a simple and higher case mix severity (8 cases total). 25-35 explicit evidence-based coring criteria were used and reported as percentage correct (0-100%).

Results: Care in the VA was significantly better (p<. 05) than the non-VA facilities regardless of whether care was evaluated using SPs or vignettes. Quality of care scores were higher even when disaggregated by condition, complexity and level of training (residents and attendings) (p<. 05). This was true regardless of measurement method. We found, however, that variation of scores within a single site was greater than the variation between sites (p <. 05).

Conclusions: The average care at the VA as measured by two methods was higher than in non-VA facilities. Case mix and historical perceptions may account for some of the less favorable opinions about the VA.

Impact statement: Careful evaluation of quality demonstrates the high quality of care provided by the VA and can be done using inexpensive methods such as clinical vignettes. Past misperceptions should be countered with dissemination of findings about the quality of care in the VA. In the future, policies intended to further improve VA quality, can be evaluated easily using this valid simple measurement method