Comparison of Quality of Care for Patients in the Veterans Health Administration and Patients in a National Sample

Asch, Steven M.; McGlynn, Elizabeth A.; Hogan, Mary M.; Hayward, Rodney A.; Shekelle, Paul G; Rubenstein, Lisa V.; Keesey, Joan; Adams, John; Kerr, Eve A.

doi:10.7326/0003-4819-141-12-200412210-00010

Cited by 453 publications

(332 citation statements)

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“…We believe this is the first study to examine evidence-based quality indicators in US veterans with gout diagnosis and to examine the physician characteristics as predictors of quality of gout care. These estimates likely understate the problem for the US as a whole, because recent studies demonstrate that the VA outperforms other systems in chronic disease management (9,23). These results confirm the findings by MacLean et al (8) of gaps in care quality for patients with rheumatic diseases, and extend their findings to include patients with gout.…”

Section: Discussionmentioning

confidence: 99%

“…However, it is unlikely that quality of gout care is much worse in VA than non-VA settings, because many studies have found better quality care for patients in the veteran health administration than patients in a national sample (9) or those covered by Medicare (23). Nonetheless, studies of physician adherence to gout QIs in the general US population are needed.…”

Section: Discussionmentioning

confidence: 99%

“…Low adherence to quality indicators for treating various diseases has been found in many US health care systems (6,7), particularly for treatment of musculoskeletal diseases including rheumatoid arthritis (8), acute low back pain (6), and osteoarthritis (9), with quality scores ranging from 54% to 65%. MacLean et al (8) studied patients with rheumatoid arthritis enrolled in a nationwide US insurance company and reported quality scores of 62% for arthritis care, 52% for comorbid disease care, and 42% for health care maintenance.…”

Section: Introductionmentioning

confidence: 99%

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Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

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174

109

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Objective. To examine evidence-based quality indicators (QIs) in US veterans with gout diagnosis, and to examine the effect of demographics, heath care utilization/access, comorbid conditions, or physican characteristics as predictors of quality of gout care. Methods. Using the Minneapolis Veterans Affairs electronic medical record system, we identified a cohort of veterans receiving medication to treat gout between January 1, 1999 and December 31, 2003, and evaluated 3 recently published evidence-based QIs for gout management: QI 1 ‫؍‬ allopurinol dose <300 mg in gout patients with renal insufficiency, QI 2 ‫؍‬ uric acid check within 6 months of starting a new allopurinol prescription, and QI 3 ‫؍‬ complete blood count and creatine kinase check every 6 months for gout patients receiving prolonged colchicine therapy. We calculated the proportion of patients whose therapy adhered to each QI and to all applicable indicators (overall physician adherence). Logistic regression analysis examined association of overall physician adherence with sociodemographics, health care utilization, comorbidity, and provider characteristics. Results. Of 3,658 patients with a diagnosis of gout, 663 patients qualified for examination of >1 QI. Of these 663 patients, therapy in only 144 (22%) adhered to all applicable QIs; 59 (78%) of 76 adhered to QI 1, 155 (24%) of 643 adhered to QI 2, and 18 (35%) of 52 adhered to QI 3. Overall physician adherence to QIs was significantly lower in older veterans and in those with more inpatient visits per year, but was higher in those with more primary care visits or more health care providers. Conclusion. Suboptimal physician adherence to QIs was seen for all 3 QIs tested in this cohort of veterans with gout. These findings can guide quality improvement efforts.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Quality of care for gout in the US needs improvement

Singh

Hodges

Toscano

et al. 2007

Arthritis & Rheumatism

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174

109

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“…Yet performance measurement is itself an intervention, sometimes with unintentional and unforeseen consequences. 2,3 For example, the Veterans Health Administration (VHA) has long had a reputation as a leader in innovative clinical performance measurement, 4 yet perverse performance incentives around performance on access-to-care measures may have exacerbated the VHA's recent crisis of confidence. 5 Even before that crisis, the VHA organized a state-of-the-art conference (SOTA) featuring thought leaders of national prominence to set goals for the next generation of clinical performance measures.…”

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confidence: 99%

Measuring What Matters in Health: Lessons from the Veterans Health Administration State of the Art Conference

Asch

Kerr

2016

J GEN INTERN MED

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“…For example, in 2004 a RAND Corporation study measured the quality of medical care using a chart-based quality instrument consisting of 348 indicators. The study found that the VHA had substantially better quality of care than did a national sample [1]. Similarly, a 2009 Congressional Budget Office report [2] found that ''the care provided to VHA patients compares favorably with that provided to non-VHA patients in terms of compliance with widely recognized clinical guidelinesparticularly those that the VHA has emphasized in its internal performance measurement system.''…”

mentioning

confidence: 96%