Post by Admin on Apr 25, 2017 9:16:20 GMT -5
Given all the media coverage about how 'bad' VA care is, a government study was done in 2016 by the Centers for Medicare and Medicaid (CMS) comparing VA Quality of care vs. non-VA hospitals. A group of scientists at Northwestern University found it to be "inconclusive and had methodological limitations" so they did an independent study comparing 129 VA hospitals with 4010 Non-VA hospitals 2012-2015. Published online April 17, 2017 by the prestigious Journal of the American Medical Association(JAMA). Blay et. al. compared VA to Non-VA Hospitals using nine metrics (sets of criteria and standards). The VA exceeded the non VA hospitals in six of nine categories, and was equal to the non-VA hospitals in the remaining 3 categories. Yes, you read that right -- VA much better than non-VA hospitals!!
And what!? This was not put immediately onto newspapers nationwide as banner headlines like, "VA Hospitals MUCH BETTER than Non-VA Hospitals!.? No, of course it wasn't.
Just saying...
Yes, the research does point out ways and areas which the VA needs to improve, but for this reader the fact that an independent research group -- with no dog in this fight -- researched and found what so many of us vets have been saying privately -- that VA care is NOT as portrayed in so much of the media. I hasten to add that of course all the misdeeds and problems brought forward, the various systemic failures etc need to be fixed and are being addressed -- albeit slowly. But at last an objective third party validates that -- in spite of its burdensome bureaucracy and resistance to change -- the VA still managed in 2012-2015 to provide better care to veterans than they would get elsewhere.
And what!? This was not put immediately onto newspapers nationwide as banner headlines like, "VA Hospitals MUCH BETTER than Non-VA Hospitals!.? No, of course it wasn't.
Just saying...
Yes, the research does point out ways and areas which the VA needs to improve, but for this reader the fact that an independent research group -- with no dog in this fight -- researched and found what so many of us vets have been saying privately -- that VA care is NOT as portrayed in so much of the media. I hasten to add that of course all the misdeeds and problems brought forward, the various systemic failures etc need to be fixed and are being addressed -- albeit slowly. But at last an objective third party validates that -- in spite of its burdensome bureaucracy and resistance to change -- the VA still managed in 2012-2015 to provide better care to veterans than they would get elsewhere.
Here is the summary page of the study, chaired by Eddie Blay, MD, JAMA Internal Medicine:
RESEARCH LETTER
Initial Public Reporting of Quality at Veterans Affairs
vs Non–Veterans Affairs Hospitals
Recently, the Centers for Medicare and Medicaid (CMS)
announced the inclusion of Veterans Affairs (VA) hospital
performance data on its Hospital Compare website.1 Prior
to this release, comparisons of quality at VA vs non-VA
hospitals were inconclusive and had methodological
limitations.2,3 Given longstanding concerns about care at VA
hospitals,4 our objective was to compare available outcome,
patient experience, and behavioral health measures between
VA and non-VA hospitals.
Methods | Hospital-level data were obtained for 129 VA and
4010 non-VA hospitals through the CMS Hospital Compare
website (reporting period spanned July 2012-March 2015)
and were merged with 2014 American Hospital Association
Annual Survey data. Non-VA hospitals were classified as
major teaching (based on Council of Teaching Hospitals
membership), other teaching, community, specialty, and
critical access hospitals. t Tests with and without Bonferroni
correction for multiple comparisons were used to evaluate
pairwise comparisons between VA and non-VA hospitals for
risk-adjusted rates of 17 outcome measures (9 Agency for
Healthcare Research and Quality Patient Safety Indicators
[PSIs], 4 mortality measures, 4 readmissions measures),
10 patient experience measures, and 9 behavioral health
measures.
Results | Veterans Affairs hospitals had better outcomes than
non-VA hospitals for 6 of 9 PSIs. There were no significant
differences for the other 3 PSIs (Table 1). In addition, VA hospitals
had better outcomes for all the mortality and readmissions
metrics (Table 1). However, on the patient experience
measures, non-VA hospitals scored better overall than VA
hospitals for nursing and physician communication, responsiveness,
quietness, pain management, and on whether the
patient would recommend the hospital to others (Table 2).
For behavioral health measures, non-VA hospitals did better
on 4 of 9 measures, while VA hospitals did better on 1 of 9
measures (Table 2).
Discussion | In this evaluation of the most recent, comprehensive
public reporting of VA hospital quality that can be compared
with non-VA hospitals, we found that VA hospitals
performed better than non-VA hospitals for most outcome
measures, but VA hospitals performed worse on certain
patient experience measures and behavioral health measures.
A recent systematic review was inconclusive about
the quality of care provided at VA hospitals vs non-VA
hospitals.
In that analysis, VA hospitals generally performed
better than non-VA hospitals with respect to safety and
effectiveness of care; however, most of the studies in this
review examined only a subset of patients, had a smaller
sample size of non-VA Hospitals, used older data, and/or did
not examine PSIs or the current patient experience metrics
used by CMS.
There are several possible explanations for the findings
in our study. First, the VA may have invested considerable
efforts in quality improvement and care coordination over
the last 3 decades. Second, they may also have better documentation
of comorbidities that are used in the risk adjustment,
as a result of the VA unified electronic health record
system and because patients have their health care mostly
within 1 system. Third, while the mortality and readmission
measures are thought to be indicative of quality, many of the
Agency for Healthcare Research and Quality PSIs have been
questioned due to the validity of the data (ie, complications
are coded inconsistently, data are not audited) and due to
ascertainment bias. In fact, when ascertainment bias
occurs, quality measures may reflect the inverse of quality,
where hospitals performing worse may be the ones providing
higher-quality care (eg, PS1-12 venous thromboembolism
outcome measure).
While concerns remain about the validity of some of the
measures used in current public reporting of health quality,
the available data suggests that VA hospitals have a similar
or more favorable quality compared with non-VA hospitals.
On the other hand, these results suggest that VA hospitals
should focus on improving certain aspects of patient experience
and behavioral health. Hospitals can use these data to
identify opportunities for quality improvement.
Eddie Blay Jr, MD
John Oliver DeLancey,MD, MPH
D. Brock Hewitt,MD, MPH
JeanetteW. Chung, PhD
Karl Y. Bilimoria, MD,MS
Author Affiliations: Surgical Outcomes and Quality Improvement Center,
Department of Surgery and Center for Healthcare Studies, Feinberg School of
Medicine, Northwestern University, Chicago, Illinois.
Corresponding Author: Karl Y. Bilimoria, MD,MS, Surgical Outcomes and
Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School
of Medicine, Northwestern Medicine, Northwestern University, 633 N St Clair
St, 20th Floor, Chicago, IL 60611 (k-bilimoria@northwestern.edu).
Accepted for Publication: February 16, 2017.
Published Online: April 17, 2017. doi:10.1001/jamainternmed.2017.0605
Author Contributions: Dr Bilimoria had full access to all of the data in the study
and takes responsibility for the integrity of the data and the accuracy of the data
analysis.
Study concept and design: Blay, Chung, Bilimoria.
Acquisition, analysis, or interpretation of data: Blay, DeLancey, Hewitt, Bilimoria.
Drafting of the manuscript: Blay, Hewitt, Bilimoria.
Critical revision of the manuscript for important intellectual content: All authors.
jamainternalmedicine.com (Reprinted) JAMA Internal Medicine Published online April 17, 2017
source:
jamanetwork.com/journals/jamainternalmedicine/article-abstract/2618816?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamainternmed.2017.0605
RESEARCH LETTER
Initial Public Reporting of Quality at Veterans Affairs
vs Non–Veterans Affairs Hospitals
Recently, the Centers for Medicare and Medicaid (CMS)
announced the inclusion of Veterans Affairs (VA) hospital
performance data on its Hospital Compare website.1 Prior
to this release, comparisons of quality at VA vs non-VA
hospitals were inconclusive and had methodological
limitations.2,3 Given longstanding concerns about care at VA
hospitals,4 our objective was to compare available outcome,
patient experience, and behavioral health measures between
VA and non-VA hospitals.
Methods | Hospital-level data were obtained for 129 VA and
4010 non-VA hospitals through the CMS Hospital Compare
website (reporting period spanned July 2012-March 2015)
and were merged with 2014 American Hospital Association
Annual Survey data. Non-VA hospitals were classified as
major teaching (based on Council of Teaching Hospitals
membership), other teaching, community, specialty, and
critical access hospitals. t Tests with and without Bonferroni
correction for multiple comparisons were used to evaluate
pairwise comparisons between VA and non-VA hospitals for
risk-adjusted rates of 17 outcome measures (9 Agency for
Healthcare Research and Quality Patient Safety Indicators
[PSIs], 4 mortality measures, 4 readmissions measures),
10 patient experience measures, and 9 behavioral health
measures.
Results | Veterans Affairs hospitals had better outcomes than
non-VA hospitals for 6 of 9 PSIs. There were no significant
differences for the other 3 PSIs (Table 1). In addition, VA hospitals
had better outcomes for all the mortality and readmissions
metrics (Table 1). However, on the patient experience
measures, non-VA hospitals scored better overall than VA
hospitals for nursing and physician communication, responsiveness,
quietness, pain management, and on whether the
patient would recommend the hospital to others (Table 2).
For behavioral health measures, non-VA hospitals did better
on 4 of 9 measures, while VA hospitals did better on 1 of 9
measures (Table 2).
Discussion | In this evaluation of the most recent, comprehensive
public reporting of VA hospital quality that can be compared
with non-VA hospitals, we found that VA hospitals
performed better than non-VA hospitals for most outcome
measures, but VA hospitals performed worse on certain
patient experience measures and behavioral health measures.
A recent systematic review was inconclusive about
the quality of care provided at VA hospitals vs non-VA
hospitals.
In that analysis, VA hospitals generally performed
better than non-VA hospitals with respect to safety and
effectiveness of care; however, most of the studies in this
review examined only a subset of patients, had a smaller
sample size of non-VA Hospitals, used older data, and/or did
not examine PSIs or the current patient experience metrics
used by CMS.
There are several possible explanations for the findings
in our study. First, the VA may have invested considerable
efforts in quality improvement and care coordination over
the last 3 decades. Second, they may also have better documentation
of comorbidities that are used in the risk adjustment,
as a result of the VA unified electronic health record
system and because patients have their health care mostly
within 1 system. Third, while the mortality and readmission
measures are thought to be indicative of quality, many of the
Agency for Healthcare Research and Quality PSIs have been
questioned due to the validity of the data (ie, complications
are coded inconsistently, data are not audited) and due to
ascertainment bias. In fact, when ascertainment bias
occurs, quality measures may reflect the inverse of quality,
where hospitals performing worse may be the ones providing
higher-quality care (eg, PS1-12 venous thromboembolism
outcome measure).
While concerns remain about the validity of some of the
measures used in current public reporting of health quality,
the available data suggests that VA hospitals have a similar
or more favorable quality compared with non-VA hospitals.
On the other hand, these results suggest that VA hospitals
should focus on improving certain aspects of patient experience
and behavioral health. Hospitals can use these data to
identify opportunities for quality improvement.
Eddie Blay Jr, MD
John Oliver DeLancey,MD, MPH
D. Brock Hewitt,MD, MPH
JeanetteW. Chung, PhD
Karl Y. Bilimoria, MD,MS
Author Affiliations: Surgical Outcomes and Quality Improvement Center,
Department of Surgery and Center for Healthcare Studies, Feinberg School of
Medicine, Northwestern University, Chicago, Illinois.
Corresponding Author: Karl Y. Bilimoria, MD,MS, Surgical Outcomes and
Quality Improvement Center (SOQIC), Department of Surgery, Feinberg School
of Medicine, Northwestern Medicine, Northwestern University, 633 N St Clair
St, 20th Floor, Chicago, IL 60611 (k-bilimoria@northwestern.edu).
Accepted for Publication: February 16, 2017.
Published Online: April 17, 2017. doi:10.1001/jamainternmed.2017.0605
Author Contributions: Dr Bilimoria had full access to all of the data in the study
and takes responsibility for the integrity of the data and the accuracy of the data
analysis.
Study concept and design: Blay, Chung, Bilimoria.
Acquisition, analysis, or interpretation of data: Blay, DeLancey, Hewitt, Bilimoria.
Drafting of the manuscript: Blay, Hewitt, Bilimoria.
Critical revision of the manuscript for important intellectual content: All authors.
jamainternalmedicine.com (Reprinted) JAMA Internal Medicine Published online April 17, 2017
source:
jamanetwork.com/journals/jamainternalmedicine/article-abstract/2618816?utm_campaign=articlePDF&utm_medium=articlePDFlink&utm_source=articlePDF&utm_content=jamainternmed.2017.0605