Comparing measures of patient safety for inpatient care provided to veterans within and outside the VA system in New York

Abstract

Using AHRQ's PSI software, male veterans in New York who obtain their inpatient care within the VA received care that was comparable with or somewhat better than those who obtained their inpatient care outside the VA. The experiences of older patients reflected those of younger patients. Given that our findings are much more similar to reported comparisons between the VA and Medicare than to comparisons between the VA and the general population, we conclude that, should system comparisons be made, choice of comparison groups will be critical to accurate interpretation of findings; however, prior to such interpretation, the validity of the PSIs must be determined within VA.

Measuring the cost of hospital adverse patient safety events

“…Evidence outside of VA does suggest that the PSIs generally exhibit high specificity (low false-positive rates) and modest sensitivity (moderate false-negative rates) (Zhan et al, 2007;Houchens et al, 2008), and the National Quality Forum has recently endorsed three of the PSIs (accidental puncture or laceration, iatrogenic pneumothorax, and PE/DVT). However it is also increasingly recognized that PSI accuracy can be improved though incorporation of data that distinguishes between pre-existing comorbidities that are present on admission from complications that arise during the hospitalization (Houchens et al, 2008;Weeks et al, 2008). Validation of the VA PSIs is currently being conducted, and moderate sensitivities and positive predictive values have been found for five PSIs evaluated to date (Romano et al, 2009).…”

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

“…[47][48][49] Effectiveness Seventeen studies showed better performance in VA facilities, while three had similar performance, one was mixed, and three were worse than non-VA settings. 51 Receipt of diabetes education and annual HbA1c tests was higher among VA patients compared with veterans in non-VA care.…”

Validity of the indicator ‘death in low‐mortality diagnosis‐related groups’ for measuring patient safety and healthcare quality in hospitals

“…The risk‐adjusted rate of ‘death in low‐mortality DRG’ was significantly higher for care obtained within the VA system (risk‐adjusted rate 0.35% (95% CI 0.26–0.44)) than outside the system (risk‐adjusted rate 0.07% (95% CI 0.02–0.12%)). However, for all other PSI tested the risk‐adjusted rates were either not significantly different or significantly lower within the VA system than those outside the system 18 . The authors suggest that this variation may reflect difference in DRG coding practices between VA and non‐VA care; however, the conflicting results between rates of ‘death in low‐mortality DRG’ and other PSI are a cause for concern.…”

“…A retrospective cohort study of veterans in New York State compared quality of care between patients receiving care outside and within the VA system for years 1998–2000 18 . The risk‐adjusted rate of ‘death in low‐mortality DRG’ was significantly higher for care obtained within the VA system (risk‐adjusted rate 0.35% (95% CI 0.26–0.44)) than outside the system (risk‐adjusted rate 0.07% (95% CI 0.02–0.12%)).…”