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


  • An evidence synthesis of 36 studies shows that VA outperforms non-VA healthcare on quality measures assessing adherence to recommended processes of care.
  • For example, studies of care processes after an acute myocardial infarction found greater rates of evidence-based drug therapy in VA settings. 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.
  • Studies of diabetes care processes also demonstrated a performance advantage for VA; one study reported that VA outperformed commercial managed care plans on all seven measures of care processes examined (hemoglobin, lipid, and proteinuria testing, eye and foot exams, aspirin use counseling, and influenza vaccination).
  • Most studies found no significant differences in mortality rates between VA and non-VA care.

In the mid-1990s, VA launched an organizational transformation to improve its quality of care. Since this transformation, there have been both favorable and unfavorable reports of the quality of VA care published in the peer-reviewed literature and lay media. In order to better understand the totality of the evidence, this systematic review compared the quality of medical and other non-surgical care in VA and diverse non-VA healthcare settings. Investigators identified 36 studies published between 1990 and August 2009 that they used to compare domains of quality, such as evidence-based processes of care, intermediate outcomes (e.g., control of blood pressure and cholesterol), and mortality.


  • Some studies assessed either a small number of quality measures in a national sample, or a large number of indicators in a sample restricted to a few VAMCs or non-VA sites.
  • Most studies used decade-old data or assessed self-reported service use.
  • This search may have failed to identify important studies that compared VA and non-VA care.

This study was funded through HSR&D’s Evidence-based Synthesis Program. Dr. Trivedi is supported by an HSR&D Career Development Award. Drs. Glassman, Shekelle, and Asch are part of HSR&D’s Center for the Study of Healthcare Provider Behavior in Sepulveda, CA.

PubMed Logo Trivedi A, Matula S, Miake-Lye I, Glassman P, Shekelle P and Asch S. Systematic Review: Comparison of the Quality of Medical Care in VA and Non-VA Settings. Medical Care October 18, 2010:e-pub ahead of print.

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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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