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JAMA Commentary on Advancing High Performance in VA Healthcare

November 21, 2017

In the June 2017 issue of JAMA Internal Medicine, an article by Blay, et al, compared the performance of VA hospitals with non-VA hospitals on a range of clinical outcomes and performance measures and found that VA hospitals performed better than non-VA hospitals for most outcome measures (i.e., lower rates of inpatient safety events, and lower 30-day mortality and readmission rates for pneumonia and heart failure), but also scored lower for patient experience and behavioral health measures. David Atkins, MD, MPH, Director of VA’s Health Services Research and Development (HSR&D) Service, and Carolyn Clancy, MD, Executive in Charge for VHA, respond to this article by stating, in part, that with more than 150 medical centers and over 1,700 sites of care serving 6.2 million US Veterans annually, VA always will have room to improve. That being said, the finding that VA hospitals perform better on quality when compared with hospitals in the private sector is not novel. A 2017 systematic review of 69 published studies reported that VA performed as well as – or better than private healthcare systems on most clinical quality measures. One reason for VA’s high-quality outcomes is the organization’s early investment in electronic health records that help advance patient care, facilitate research, and enhance patient-physician communication. Another key factor is VA’s embedded research program – the Quality Enhancement Research Initiative (QUERI), which brings together researchers and program leaders to accelerate evidence-based practices in critical clinical areas.

Lower patient experience scores reported by Veterans regarding VA healthcare are more challenging to explain. One factor may be that VA’s physical plant and capital infrastructure are significantly older and, therefore, lack many of the private sector’s amenities (i.e., more private rooms). Whatever the reasons, an essential new lever for continuous improvement at VA is transparency. In that vein, VA recently launched a website (Access and Quality in VA Healthcare) that allows Veterans to compare their local VA facility’s performance on Hospital Compare metrics to private-sector facilities in the same market area. Veterans may also use this site to obtain information on wait times and patient-reported experience for both primary and specialty care.

View JAMA Internal Medicine Article Highlighting VA's Performance Measures.

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