VA and quality care


Category : General

For many years, physicians have considered the VA an inferior care system. Unbeknownst to most physicians whose only VA experience occurred during their training, the VA has made significant strides over the past 10 years. Attending on the VA wards for 5-6 months each year, I have noticed these strides. A major contributing factor is the BEST electronic medical record that I have seen.

A new study shows that the VA does a better job caring for diabetes than does managed care – Study: VA Bests Managed Care on Diabetes

Diabetic patients treated by the country’s long-maligned VA health system got better care than diabetics under managed health care plans, according to a new study.

Researchers found that the diabetics served by the Department of Veterans Affairs had better control over their cholesterol and got more frequent blood tests, eye and foot exams than diabetics served by the commercial health groups.

The findings appear in Tuesday’s issue of Annals of Internal Medicine. The study was funded by the VA, the U.S. Centers for Disease Control and Prevention, and the National Institute of Diabetes and Digestive Kidney Diseases.

“The VA has made great strides in the past 10 years,” said Dr. Eve A. Kerr, the study’s lead author, who is a research scientist at the VA Ann Arbor Healthcare System and assistant professor of internal medicine at the University of Michigan Medical School. “What this tells us is that a nationally funded health care system can provide excellent quality of care.”

Researchers compared the care received by 6,900 diabetics in eight managed care health plans with about 1,300 diabetics in five VA medical centers in Indiana, California, Texas, Michigan, Pennsylvania and New Jersey. They matched the two patient groups geographically and used statistical sampling to make the demographics comparable.

Compared to their managed care counterparts, diabetes patients treated by VA doctors more often received the recommended annual blood tests (93 percent vs. 83 percent), eye exams (91 percent vs. 75 percent); and foot exams (98 percent vs. 84 percent).

The VA group also received more cholesterol testing (79 percent vs. 63 percent) and had better control of their cholesterol levels as a result, according to the study.

Both groups of patients reported similarly high levels of satisfaction for the care they received.

Why? I would submit that 2 major factors make this result happen. First, VA doctors have more time to see each patient. As physicians have more time, they more likely will address more issues. Second, the VA electronic medical record facilitates tracking.

This study suggests an important subsequent study. We need to better understand the factors that have enabled the VA to surpass managed care. That study might inform a reconsideration of primary care.

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Comments (5)

I suspect those quality of health care indicators may be better due to the “focus” of so many of the outpatient VA clinics I have seen.

1. many outpatient clinics do not require physicians to have night time call duty or even hospital rounding at all. Uninterrupted sleep, free weekends and ample clinic holidays lead to better rested minds during the remaining workdays

2. no worry about the financials of running an office. no managed care HASSLES, billing issues, overheaad conccerns,
3. Less worry about medlpractice probably FREES the physician to focus on fixing the problem rather than ordering a test, making a referall or dictating a note for CYA purposes.

maybe i’m wrong

The authors conclude that “a federally sponsored national health care organization can provide care that is equivalent to or better than that provided by high-performing commercial managed care plans.” No wonder the New York Times liked this. I’m concerned about conflicts of interest, in that the study received support from the VA and other government agencies, and the lead author if a VA physician.

Among numerous flaws in the study is the fact that surrogate outcomes and process indicators rather than clinical outcomes were studied. (If memory serves, the VA historicaly has not fared well in terms of clinical outcomes). Also of interest, this study was conducted before the revolutionary advance in basal/bolus insulin therapy was made possible by the introduction of glargine insulin in April 2004. Since that time there has emerged a disparity in diabetes treatment, as the VA has been laggard to offer it to patients. Finally, although it’s not entirely clear to me I suspect that the VA centers studied in this report were mainly affiliated with academic medical centers which provide them with the best and brightest of physicians, and emphasize process adherence to their trainees. This may not represent a valid cross section of VA care.

Might this be another example of science with an agenda?

Oops! In the post above I meant to say that glargine was introduced in April 2000. Sorry.

despite the study flaws, what I take away from this is that the quality of practice is affectedd greatly by the environments we practice.

sorry post call fatigue affected my typing accuracy above…should be ….”quality of practice is affected greatly by the environments in which we practice”

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