Comparison of quality of care for patients in the Veterans Health Administration and patients in a national sample

Background: The Veterans Health Administration (VITA) has introduced an integrated electronic medical record, performance measurement, and other system changes directed at improving care. Recent comparisons with other delivery systems have been limited to a small set of indicators. Objective: To compare the quality of VITA care with that of care in a national sample by using a comprehensive quality-of-care measure. Design: Cross-sectional comparison. Setting: 12 VITA health care systems and 12 communities. Patients: 596 VITA patients and 992 patients identified through random-digit dialing. All were men older than 35 years of age. Measurements: Between 1997 and 2000, quality was measured by using a chart-based quality instrument consisting of 348 indicators targeting 26 conditions. Results were adjusted for clustering, age, number of visits, and medical conditions. Results: Patients from the VITA scored significantly higher for adjusted overall quality (67% vs. 51%; difference, 16 percentage points [95% CI, 14 to 18 percentage points]), chronic disease care (72% vs. 59%; difference, 13 percentage points [CI, 10 to 17 percentage points]), and preventive care (64% vs. 44%; difference, 20 percentage points [CI, 12 to 28 percentage points]), but not for acute care. The VITA advantage was most prominent in processes targeted by VITA performance measurement (66% vs. 43%; difference, 23 percentage points [CI, 21 to 26 percentage points]) and least prominent in areas unrelated to VITA performance measurement (55% vs. 50%; difference, 5 percentage points [CI, 0 to 10 percentage points]). Limitations: Unmeasured residual differences in patient characteristics, a lower response rate in the national sample, and differences in documentation practices could have contributed to some of the observed differences. Conclusions: Patients from the VITA received higher-quality care according to a broad measure. Differences were greatest in areas where the VITA has established performance measures and actively monitors performance.