Chronic Obstructive Pulmonary Disease Outcomes at Veterans Affairs Versus Non-Veterans Affairs Hospitals

LaBedz, S.L.; Krishnan, Jerry A.; Chung, Y.; Lindenauer, Peter K.; Spece, Laura J; Feemster, Laura C.; Stein, Ellen M.; Buhr, Russell G.; Basu, Sanjib; Prieto-Centurion, Valentin

doi:10.15326/jcopdf.2021.0201

Cited by 8 publications

(12 citation statements)

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“…Twenty-five included studies 8 , 11 , 12 , 14 – 16 , 19 – 22 , 24 , 25 , 27 , 28 , 30 , 32 , 33 , 35 , 37 , 39 – 44 met all our risk of bias criteria. These good quality studies were given more weight in our narrative synthesis than studies that did not meet one or more criterion.…”

Section: Resultsmentioning

confidence: 99%

Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

et al. 2023

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Background The Veterans Health Administration (VA) serves Veterans in the nation’s largest integrated healthcare system. VA seeks to provide high quality of healthcare to Veterans, but due to the VA Choice and MISSION Acts, VA increasingly pays for care outside of its system in the community. This systematic review compares care provided in VA and non-VA settings, and includes published studies from 2015 to 2023, updating 2 prior systematic reviews on this topic. Methods We searched PubMed, Web of Science, and PsychINFO from 2015 to 2023 for published literature comparing VA and non-VA care, including VA-paid community care. Records were included at the abstract or full-text level if they compared VA medical care with care provided in other healthcare systems, and included clinical quality, safety, access, patient experience, efficiency (cost), or equity outcomes. Data from included studies was abstracted by two independent reviewers, with disagreements resolved by consensus. Results were synthesized narratively and via graphical evidence maps. Results Thirty-seven studies were included after screening 2415 titles. Twelve studies compared VA and VA-paid community care. Most studies assessed clinical quality and safety, and studies of access were second most common. Only six studies assessed patient experience and six assessed cost or efficiency. Clinical quality and safety of VA care was better than or equal to non-VA care in most studies. Patient experience in VA care was better than or equal to experience in non-VA care in all studies, but access and cost/efficiency outcomes were mixed. Discussion VA care is consistently as good as or better than non-VA care in terms of clinical quality and safety. Access, cost/efficiency, and patient experience between the two systems are not well studied. Further research is needed on these outcomes and on services widely used by Veterans in VA-paid community care, like physical medicine and rehabilitation.

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Section: Resultsmentioning

confidence: 99%

Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

et al. 2023

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“… 17 We found lower mortality for HF and stroke but not AMI in VA hospitals, while another study found lower mortality for AMI and HF in VA hospitals but did not include stroke in a study of adults aged 65 years and older. 13 That study included veterans and nonveterans in an earlier period, which may explain different findings. 8 …”

Section: Discussionmentioning

confidence: 96%

“… 5 , 6 , 7 , 8 Many of these prior studies were limited to older veterans using VA services and older patients using Medicare services, including many nonveterans, due to wide availability of Medicare data. 8 , 9 , 10 , 11 , 12 , 13 , 14 However, the veteran enrollee population is more male and has worse health status, greater disability, and lower incomes compared with the nonveteran population. 15 , 16 Moreover, younger veterans are typically not included in comparisons due to a lack of comprehensive data on non-VA use outside of Medicare, which reduces the generalizability of these comparisons.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of Veterans Treated in Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals

Yoon,

Phibbs,

Ong

et al. 2023

JAMA Netw Open

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ImportanceMany veterans enrolled in the Veterans Affairs (VA) health care system have access to non-VA care through insurance and VA-purchased community care. Prior comparisons of VA and non-VA hospital outcomes have been limited to subpopulations.ObjectiveTo compare outcomes for 6 acute conditions in VA and non-VA hospitals for younger and older veterans using VA and all-payer discharge data.Design, Setting, and ParticipantsThis cohort study used a repeated cross-sectional analysis of hospitalization records for acute myocardial infarction (AMI), coronary artery bypass graft (CABG), gastrointestinal (GI) hemorrhage, heart failure (HF), pneumonia, and stroke. Participants included VA enrollees from 11 states at VA and non-VA hospitals from 2012 to 2017. Analysis was conducted from July 1, 2022, to October 18, 2023.ExposuresTreatment in VA or non-VA hospital.Main Outcome and MeasuresThirty-day mortality, 30-day readmission, length of stay (LOS), and costs. Average treatment outcomes of VA hospitals were estimated using inverse probability weighted regression adjustment to account for selection into hospitals. Models were stratified by veterans’ age (aged less than 65 years and aged 65 years and older).ResultsThere was a total of 593 578 hospitalizations and 414 861 patients with mean (SD) age 75 (12) years, 405 602 males (98%), 442 297 hospitalizations of non-Hispanic White individuals (75%) and 73 155 hospitalizations of non-Hispanic Black individuals (12%) overall. VA hospitalizations had a lower probability of 30-day mortality for HF (age ≥65 years, −0.02 [95% CI, −0.03 to −0.01]) and stroke (age &lt;65 years, −0.03 [95% CI, −0.05 to −0.02]; age ≥65 years, −0.05 [95% CI, −0.07 to −0.03]). VA hospitalizations had a lower probability of 30-day readmission for CABG (age &lt;65 years, −0.04 [95% CI, −0.06 to −0.01]; age ≥65 years, −0.05 [95% CI, −0.07 to −0.02]), GI hemorrhage (age &lt;65 years, −0.04 [95% CI, −0.06 to −0.03]), HF (age &lt;65 years, −0.05 [95% CI, −0.07 to −0.03]), pneumonia (age &lt;65 years, −0.04 [95% CI, −0.06 to −0.03]; age ≥65 years, −0.03 [95% CI, −0.04 to −0.02]), and stroke (age &lt;65 years, −0.11 [95% CI, −0.13 to −0.09]; age ≥65 years, −0.13 [95% CI, −0.16 to −0.10]) but higher probability of readmission for AMI (age &lt;65 years, 0.04 [95% CI, 0.01 to 0.06]). VA hospitalizations had a longer mean LOS and higher costs for all conditions, except AMI and stroke in younger patients.Conclusions and RelevanceIn this cohort study of veterans, VA hospitalizations had lower mortality for HF and stroke and lower readmissions, longer LOS, and higher costs for most conditions compared with non-VA hospitalizations with differences by condition and age group. There were tradeoffs between better outcomes and higher resource use in VA hospitals for some conditions.

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“… 43 These initiatives likely explain the recent finding of lower rates for 30-day re-admissions following hospitalizations for COPD at VA relative to non-VA hospitals. 44 …”

Section: Physiological Outcomes and Interventions To Optimize Them In...mentioning

confidence: 99%

Improving Physiological, Physical, and Psychological Health Outcomes: A Narrative Review in US Veterans with COPD

Bamonti

Robinson

Wan

et al. 2022

COPD

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Chronic Obstructive Pulmonary Disease Outcomes at Veterans Affairs Versus Non-Veterans Affairs Hospitals

Abstract: For personal use only. Permission required for all other uses.

Cited by 8 publications

References 0 publications

Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

Outcomes of Veterans Treated in Veterans Affairs Hospitals vs Non–Veterans Affairs Hospitals

Improving Physiological, Physical, and Psychological Health Outcomes: A Narrative Review in US Veterans with COPD

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