Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

1055 — Ambulatory Care Quality at Veterans Affairs Medical Centers

Ross JS (TREP - Bronx) , Keyhani S (TREP - Bronx), Keenan PS (Yale University), Bernheim SM (Yale University), Penrod JD (TREP - Bronx), Boockvar KS (TREP - Bronx), Siu AL (TREP - Bronx)

Objectives:
To compare use of recommended ambulatory care among insured adults receiving some or all of their healthcare from Veterans Affairs medical centers (VAMCs) to those receiving no care at VAMCs.

Methods:
We performed a cross-sectional analysis of data from the 2003 Behavior Risk Factor Surveillance System, a nationally-representative sample including 219,353 community-dwelling, insured adults aged 18 years or older. Our main outcome measures were defined by age-, sex-, and co-morbid condition-specific national guideline recommendations: self-reported use of screening for breast, prostate, and colorectal cancer; cholesterol screening, aspirin use, and tobacco cessation and weight-loss counseling for cardiovascular risk reduction; influenza and pneumococcal vaccination for infectious disease prevention; and cholesterol and glycosylated hemoglobin measurement, eye and foot examination, and influenza and pneumococcal vaccination for diabetes management. We used multivariable logistic regression, adjusting for socio-demographic characteristics and health status, to examine the association between ambulatory care quality and receiving care at VAMCs.

Results:
In our sample, 5,680 (2.6%) insured adults received some or all of their healthcare from VAMCs. Among eligible adults, ambulatory service use ranged from 38% for weight loss counseling among obese adults to 88% for cholesterol screening and 90% for glycosylated hemoglobin measurement. When compared with receiving no care at VAMCs, receiving care at VAMCs was associated with increased use of recommended ambulatory care for all examined services (P-values < 0.03), except for breast cancer screening (P=0.06) and regular aspirin use among adults with cardiovascular disease (P=0.45). Among services for which receiving care at VAMCs was associated with increased use, we found associations ranged from 3% increased use of glycosylated hemoglobin measurement to 31% increased use of colorectal cancer screening and 45% increased use of pneumococcal vaccination among adults with diabetes. There were no consistent associations between increased use of recommended care and receiving all care at VAMCs when compared with receiving some care at VAMCs.

Implications:
Adults receiving care at VAMCs reported higher-quality ambulatory care across a variety of services.

Impacts:
Despite increased attention to healthcare quality among all health systems, VAMCs continue to provide higher-quality ambulatory care, perhaps as a consequence of an automated patient tracking and provider reminder system.