Comments on: VA and quality care http://www.medrants.com/archives/2049 Contemplating medicine and the health care system Sun, 14 Mar 2010 00:12:54 +0000 http://wordpress.org/?v=2.9.2 hourly 1 By: kmh http://www.medrants.com/archives/2049/comment-page-1#comment-4433 kmh Fri, 20 Aug 2004 02:48:07 +0000 http://medrants.com/archives/2004/08/17/va-and-quality-care/#comment-4433 sorry post call fatigue affected my typing accuracy above...should be ...."quality of practice is affected greatly by the environments in which 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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]]> By: kmh http://www.medrants.com/archives/2049/comment-page-1#comment-4431 kmh Thu, 19 Aug 2004 03:48:23 +0000 http://medrants.com/archives/2004/08/17/va-and-quality-care/#comment-4431 despite the study flaws, what I take away from this is that the quality of practice is affectedd greatly by the environments we practice. despite the study flaws, what I take away from this is that the quality of practice is affectedd greatly by the environments we practice.

]]> By: Robert W. Donenll http://www.medrants.com/archives/2049/comment-page-1#comment-4426 Robert W. Donenll Wed, 18 Aug 2004 03:00:51 +0000 http://medrants.com/archives/2004/08/17/va-and-quality-care/#comment-4426 Oops! In the post above I meant to say that glargine was introduced in April 2000. Sorry. Oops! In the post above I meant to say that glargine was introduced in April 2000. Sorry.

]]> By: Robert W. Donenll http://www.medrants.com/archives/2049/comment-page-1#comment-4425 Robert W. Donenll Wed, 18 Aug 2004 02:59:00 +0000 http://medrants.com/archives/2004/08/17/va-and-quality-care/#comment-4425 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? 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?

]]> By: kmh http://www.medrants.com/archives/2049/comment-page-1#comment-4424 kmh Wed, 18 Aug 2004 01:53:53 +0000 http://medrants.com/archives/2004/08/17/va-and-quality-care/#comment-4424 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 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

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