Care Within VHA Hospitals Outperforms Non-VHA Hospitals

According to a recent study, Veteran Health Administration (VHA) hospitals provided the best care in most hospital referral regions and rarely provided the worst care.

The authors of the study, William Weeks, MD, PhD, and Alan West, PhD, explained that past studies have compared a representative sample of VHA patients or hospitals with a representative sample not in the VHA system. The authors of the study explained that this can cause misleading results due to various circumstances.

“The VHA may provide better care than the private sector in every local area,” Drs Weeks and West explained. “Alternatively, non-VHA care may be better than VHA care in more local areas but by a small amount, whereas VHA care may be better than non-VHA care in fewer local areas by a large amount in each area.”

To determine whether several outcomes of VHA and non-VHA care in the same region differ, the study authors identified 15 outcome measures that were reported by VHA and non-VHA hospitals. The researchers used data from the Hospital Compare website. The measures identified included 30-day risk-adjusted mortality rates for four common disease plus 11 additional patient safety indicators. Further, the study team used each hospital’s zip code to assign the hospital to one of 306 hospital referral regions. Ultimately, the researchers limited the analyses to the 121 regions in which at least one VHA and one non-VHA hospital reported at least one of the measures identified. Among each measure and region, the researchers determined whether scores of a VHA hospital were the best, above average, or the worst among all other hospitals in the same region.

“When we considered all regions together, VHA care was significantly better than non-VHA care for 14 of the 15 measures, which confirms the findings of previous studies,” the researchers reported. “A VHA hospital also provided the best care in at least 50% of the regions for 9 of the 15 measures, above-average care in at least 67% of the regions for 14 measures, and the worst care in fewer than 15% of the regions for 14 measures.”

The researchers concluded that although VHA hospitals provided the best care in most hospital referral regions, they noted that VHA and non-VHA hospitals may report data differently to Hospital Compare. They recommended that VHA and Centers for Medicare and Medicaid Services should take steps to ensure that the methods they use to calculate Hospital Compare data present fair comparisons.

“This finding may indicate that the VHA generally provides truly excellent care; if so, we believe that efforts to outsource VHA care to non-VHA settings solely for patient convenience should be reconsidered,” Dr Weeks and Dr West concluded.

—Julie Gould