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Publication Briefs

Systematic Review Shows VA Surgical Care is Comparable or Better than Non-VA Surgical Care

The Choice and MISSION Acts greatly expanded eligibility for VA-reimbursed non-VA care, but questions remain about the quality of care provided by different sites. Prior reviews comparing surgical outcomes between VA and non-VA care found that VA performed similarly to or better than non-VA care in most, but not all, aspects of clinical quality. However, these findings pre-dated Choice and MISSION Act implementation. Therefore, investigators conducted a systematic review to compare VA and non-VA care for surgical conditions across domains of quality and safety, access, patient experience, and comparative cost/efficiency using studies published between 2015 and 2021 – following implementation of the Choice and MISSION Acts. After searching PubMed and screening more than 1,800 articles, investigators identified 18 that could be used in their systematic review.


  • This systematic review of studies of surgical care comparing quality and safety, access, patient experience, and cost across several surgical specialties found that in all but two studies, VA care had comparable or better quality and safety outcomes than non-VA care.
  • For access to care, neither VA nor non-VA care was found to be consistently better.
  • Studies of patient experience were too limited to draw conclusions, and the few studies of cost and efficiency outcomes favored non-VA care.


  • Findings suggest that expanding eligibility for Veterans to receive care in the community may not provide benefits in terms of increasing access to surgical procedures or result in better quality, but may reduce inpatient length of stay and cost.


  • The outcomes and operations for which comparisons have been published may not be generalizable to all surgical procedures.

This project was funded by HSR&D’s Evidence Synthesis Program. Drs. Blegen and Salzman also were supported by the VA Office of Academic Affiliations (OAA) through the National Clinician Scholars Program (NCSP). All authors, except Ms. Ko, are part of HSR&D’s Center for the Study of Healthcare Innovation, Implementation and Policy (CSHIIP) and the VA Greater Los Angeles Healthcare System.

Blegen M, Ko J, Salzman G, Begashaw M, Ulloa J, Girgis M, Shekelle P, and Maggard-Gibbons M. Comparing Quality of Surgical Care between the U.S. Department of Veterans Affairs and non-Veterans Affairs Settings; A Systematic Review. Journal of The American College of Surgeons. May 8, 2023; online ahead of print.

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What are HSR Publication Briefs?

HSR requires notification by HSR-funded investigators about all articles accepted for publication. These journal articles are reviewed by HSR and publication briefs or summaries are written for a select number of articles that are then forwarded to VHA Central Office leadership to keep them informed about important findings or information. Articles to be summarized are selected by HSR based on timeliness of the findings, interest of leadership, or potential impact on the organization. Publication briefs are written for only a small number of HSR published articles. Visit the HSR citations database for a complete listing of HSR articles and presentations.

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