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. 2017 Jan;32(1):105-121.
doi: 10.1007/s11606-016-3775-2. Epub 2016 Jul 15.

Comparing VA and Non-VA Quality of Care: A Systematic Review

Claire O'Hanlon  1   2 , Christina Huang  3   4 , Elizabeth Sloss  5 , Rebecca Anhang Price  5 , Peter Hussey  6 , Carrie Farmer  7 , Courtney Gidengil  6
Affiliations

Comparing VA and Non-VA Quality of Care: A Systematic Review

Claire O'Hanlon et al. J Gen Intern Med. 2017 Jan.

Abstract

Background: The Veterans Affairs (VA) health care system aims to provide high-quality medical care to veterans in the USA, but the quality of VA care has recently drawn the concern of Congress. The objective of this study was to systematically review published evidence examining the quality of care provided at VA health care facilities compared to quality of care in other facilities and systems.

Methods: Building on the search strategy and results of a prior systematic review, we searched MEDLINE (from January 1, 2005, to January 1, 2015) to identify relevant articles on the quality of care at VA facilities compared to non-VA facilities. Articles from the prior systematic review published from 2005 and onward were also included and re-abstracted. Studies were classified, analyzed, and summarized by the Institute of Medicine's quality dimensions.

Results: Sixty-nine articles were identified (including 31 articles from the prior systematic review and 38 new articles) that address one or more Institute of Medicine quality dimensions: safety (34 articles), effectiveness (24 articles), efficiency (9 articles), patient-centeredness (5 articles), equity (4 articles), and timeliness (1 article). Studies of safety and effectiveness indicated generally better or equal performance, with some exceptions. Too few articles related to timeliness, equity, efficiency, and patient-centeredness were found from which to reliably draw conclusions about VA care related to these dimensions.

Discussion: The VA often (but not always) performs better than or similarly to other systems of care with regard to the safety and effectiveness of care. Additional studies of quality of care in the VA are needed on all aspects of quality, but particularly with regard to timeliness, equity, efficiency, and patient-centeredness.

Keywords: Veterans Affairs; Veterans Health Administration; quality; systematic review; veterans.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Fig. 1
Fig. 1
Flow Diagram of Included and Excluded Studies. Of the 461 articles identified using our search strategies, 306 were excluded at title/abstract screening and 155 were screened for inclusion using the full text of the article. Of these, 86 were excluded, leaving 38 new articles for data abstraction. These articles were combined with the 31 articles from the prior review that met inclusion criteria, resulting in the 69 articles included in this systematic review.
See this image and copyright information in PMC

Comment in

  • Comparing VA to Non-VA Care.
    Weeks WB. Weeks WB. J Gen Intern Med. 2017 Feb;32(2):150-151. doi: 10.1007/s11606-016-3893-x. J Gen Intern Med. 2017. PMID: 27730485 Free PMC article. No abstract available.
  • Comparing VA to Non-VA Care.
    O'Hanlon CE, Farmer C, Gidengil C. O'Hanlon CE, et al. J Gen Intern Med. 2017 Feb;32(2):152. doi: 10.1007/s11606-016-3892-y. J Gen Intern Med. 2017. PMID: 27761768 Free PMC article. No abstract available.
  • Lessons from the Rise-and Fall?-of VA Healthcare.
    Hayward RA. Hayward RA. J Gen Intern Med. 2017 Jan;32(1):11-13. doi: 10.1007/s11606-016-3865-1. J Gen Intern Med. 2017. PMID: 27966056 Free PMC article. No abstract available.

References

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    1. Khuri SF, Daley J, Henderson WG. The comparative assessment and improvement of quality of surgical care in the department of veterans affairs. Arch Surg-Chicago. 2002;137(1):20–7. doi: 10.1001/archsurg.137.1.20. - DOI - PubMed
    1. Veterans Choice Act. II—Health Care Administrative Matters; 2014.
    1. Clancy CM. Independent assessment of Department of Veterans Affairs health care delivery systems and management processes (memorandum to Department of Veterans Affairs leadership), October 9, 2014.
    1. Saha S, Freeman M, Toure J, Tippens K, Weeks C, Ibrahim S. Racial and ethnic disparities in the VA Health care system: a systematic review. J Gen Intern Med. 2008;23(5):654–71. doi: 10.1007/s11606-008-0521-4. - DOI - PMC - PubMed

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