VA versus Non-VA Quality of Care: A Systematic Review

Shekelle PG, Maggard-Gibbons M, Blegen M, Apaydin EA, Paige N, Ko J, Ulloa JG, Salzman GA, Begashaw M, Girgis MD, Larkin JJ. VA versus Non-VA Quality of Care: A Systematic Review. Evidence Synthesis Program. Washington DC: Health Services Research and Development Service, Office of Research and Development, Department of Veterans Affairs; 2022 Nov 1. 1-130 p.

Takeaway In general, most published studies of comparisons of quality of care show that Veterans getting care from VA get the same or better quality care than Veterans getting VA-paid community care or the general public getting non-VA care. Context The Department of Veterans Affairs (VA) is the nation's largest integrated healthcare system. Comparisons of VA-delivered care to care delivered in non-VA settings is central to assessing the quality of VA care. This systematic review updates two prior systematic reviews on this topic. Key Findings From 1818 titles we identified 32 studies of non-surgical care meeting inclusion criteria. From 1812 titles we identified 18 studies of surgical care meeting inclusion criteria. Four studies contributed data to both. The majority of included studies assessed quality and safety. Fewer studies assessed other domains of care. In the domain of quality and safety, most studies found that VA care is as good as, or better than, care in the community. For the domains of access and of cost/efficiency, the studies were more evenly distributed between the categories of VA care is better, VA and community care are about the same, and community care is better. The few studies of patient experience found that VA care and community care were about the same, or VA care was better. We did not identify any study the found that patient experience was better in community care.