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Study Finds VA Health Care Improving

Agency actually offers more preventive measures than private sector

MONDAY, Dec. 20, 2004 (HealthDayNews) -- A new study finds that patients who use the Department of Veterans Affairs health system get better preventive care, particularly for chronic conditions, than patients in the private sector.

VA patients receive at least two-thirds of recommended care, while those using private health care get only about half, the researchers said.

The difference between VA and private care was most striking in areas where the VA had established performance requirements and actively monitored them, according to the report in the Dec. 21 issue of the Annals of Internal Medicine. The VA co-sponsored the study.

In the past, the agency had been criticized for delivering poor care, but "this is not your father's VA," said lead researcher Dr. Steven M. Asch, a physician at the VA Greater Los Angeles Health Care System and an associate professor of medicine at UCLA. "They have undergone a quality transformation in the last 10 years."

"The VA has built an information superhighway for medical care information," Asch said. "And they hold managers and providers responsible for getting good results. The VA has the systems in place to make sure the right things get done."

In their study, Asch and his colleagues collected data on 596 VA patients and 992 private sector patients. The team looked at 348 indicators of care for 26 medical conditions.

They found that, overall, VA patients received 67 percent of recommended care, compared with 51 percent of private sector patients. In addition, VA patients with chronic conditions received recommended care 72 percent of the time, while similar patients in the private sector got it 59 percent of the time.

Sixty-four percent of VA patients got such preventive measures as pneumococcal vaccination and colorectal cancer screening, compared with 44 percent of private sector patients.

Asch's team found VA patients got better care across the board, including screening, diagnosis, treatment and follow-up. When it came to acute care, the VA and private health care were equal, the researchers report.

"This study demonstrates for the first time the lift that we get in quality of care by having electronic medical markers put together with performance measures and tools that make people accountable," said co-author Elizabeth A. McGlynn, the associate director of Rand Health, a nonprofit group that worked with VA doctors on the study.

McGlynn added that other studies have shown that improving the quality of care leads to improved patient outcomes.

The VA is continuing its quality improvement program, Asch said. He believes that many of the lessons learned at the VA can be transferred to private health care. However, there are problems in getting private health care to go along with these changes. Among these are cost, he said.

"Our health-care system isn't really a system," Asch said. "There's nobody in charge." Given that, it is difficult to get the health-care system moving in one direction. Asch believes the government's role is to set standards to create a better flow of quality care information.

"It is possible to improve care patients receive," Asch continued. "We don't have to settle for what we are seeing in the rest of the country. The kind of the things the VA is doing are the kind of things the rest of the system should emulate to improve care."

"This finding is not surprising," said Dr. David U. Himmelstein, an associate professor of medicine at Harvard Medical School. "Most of us have been aware that the VA has the most vigorous quality improvement program over the last decade."

Himmelstein said that what the VA has done in improving the quality of the care it delivers is a lesson for private health care. "It gives the lie to the perception that the government is slow and behind the times in health care," he said.

"When we talk about national health insurance, people often say: 'Do you want a program that has the responsiveness of the Post Office, the heart of the IRS, and the efficiency of the Pentagon?' Yet it does look like the VA health-care system runs better than the private sector," Himmelstein said.

Himmelstein opined that the study highlights how bad private health care is. "Even the VA numbers are not very good," he noted. Moreover, "when we move toward privatizing Medicare, we're headed toward deep trouble. We're headed toward a system which is very likely to be lower quality than the government run-system we have now," he said.

Himmelstein believes private health care is reluctant to introduce quality improvement because there is no money in it. "Image is everything," he said. "The reality of improving quality is probably more expensive than the investment warrants. We have a health-care system which is ruled by the market, and the market is a lousy tool to implement quality."

More information

The Agency for Healthcare Research and Quality can tell you more about quality health care.

SOURCES: Steven M. Asch, M.D., M.P.H., VA Greater Los Angeles Health Care System, and associate professor, medicine, University of California, Los Angeles; Elizabeth A. McGlynn, Ph.D., associate director, Rand Health, Rand Corp., Santa Monica, Calif.; David U. Himmelstein, M.D., associate professor, medicine, Harvard Medical School, Boston; Dec. 21, 2004, Annals of Internal Medicine
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