Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care

Jha, Ashish K.; Perlin, Jonathan B.; Kizer, Kenneth W.; Dudley, R. Adams

doi:10.1056/nejmsa021899

Cited by 577 publications

(208 citation statements)

References 20 publications

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“…34 However, we observed higher baseline rates of uncontrolled BP (57.5%) than had others (54%), 35 possibly because we selected study sites serving large AA populations, which may not be representative of VA nationally. Since AAs with hypertension are younger on average, with higher rates of diastolic hypertension, 5 the effects of the intervention on diastolic BP may in part reflect the composition of our study participants (~75% AAs).…”

Section: Discussionmentioning

confidence: 67%

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

et al. 2016

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Results: Clinician counseling improved most at R+T. BP improved overall; R+T had a small but significantly greater reduction in diastolic BP (DBP; -1.7 mm Hg). White patients at RO experienced greater overall improvements in BP control. Site and race disparities trends suggested that disparities decreased at R+T, either stayed the same or decreased at Control; and stayed the same or increased at RO. Conclusions:More substantial or racial/ ethnically tailored interventions are needed.

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Section: Discussionmentioning

confidence: 67%

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

et al. 2016

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“…For a number of services such as vaccination, which are often administered outside of primary care settings, self-report is highly sensitive and moderately specific compared with medical records [50][51][52]. When we compared the BRFSS survey estimates to those obtained from VA sources derived from medical record review [45][46][53][54], estimates were similar, providing further evidence for confidence based on the self-reported data from the BRFSS survey. In any case, although there may be both random and systematic errors in reporting, it is unlikely that such errors would differ depending on disability.…”

Section: Discussionmentioning

confidence: 75%

“…The healthcare delivery reforms undertaken by the VA in the late 1990s have been documented previously [6,45]. Some of the factors that may be relevant for the current findings include clinical reminders, increased accountability stemming from the use of performance measures, and the creation of dedicated special primary care clinics for women [46].…”

Section: Discussionmentioning

confidence: 78%

Preventive services in veterans in relation to disability

Littman

Forsberg

Haselkorn

2012

JRRD

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Abstract-Veterans with disabilities are at an increased risk of secondary impairments and may have difficulty accessing preventive services; accessibility may differ between Veterans who do and do not receive care at Department of Veterans Affairs (VA) facilities. We used data from the 2003 and 2004 Behavioral Risk Factor Surveillance System surveys to evaluate associations between disability and receipt of preventive services in Veterans. Veterans with a disability were more likely to have received influenza vaccinations (VA users and nonusers), pneumococcal vaccinations (VA nonusers: p < 0.001; VA users: p = 0.073), weight management counseling (VA nonusers: p < 0.001; male VA users: p < 0.001), lower gastrointestinal (GI) endoscopy (VA nonusers: 50-64 yr, p = 0.03; VA users: 65 yr, p = 0.085), mammography (VA users: p = 0.097), and serum cholesterol screening (VA nonusers: p < 0.001). Receipt was similar by disability status for fecal occult blood test (FOBT), lower GI endoscopy (VA users: 50-64 yr), human immunodeficiency virus testing, and cervical cancer screening. For no measure was there significantly lower receipt in those with versus without a disability, although there was marginal evidence in VA nonusers for overall colorectal cancer screening (i.e., lower GI endoscopy or FOBT: p = 0.063). Among Veterans, having a disability did not appear to be a barrier to receiving appropriate preventive care.

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“…Previous research indicates that minority patients are more likely to receive lower quality of care across a range of conditions and care processes, and have higher morbidity and mortality rates including some patient safety indicators on selected outcomes. [2][3][4][5][6][7][8][9][10][11][12][13] Patient safety indicators (PSIs), developed by the Agency for Healthcare Research and Quality (AHRQ), are a set of indicators providing information on potential in-hospital complications and adverse events following surgeries, procedures, and childbirth. The PSIs were developed after a comprehensive literature review, analysis of ICD-9-CM codes, review by a clinician panel, implementation of risk adjustment, and empirical analyses.…”

Section: Introductionmentioning

confidence: 99%

Racial and Insurance Status Disparities in Patient Safety Indicators among Hospitalized Patients

et al. 2016

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Objective: To examine the association between patient race/ethnicity, insurance status, and their interaction with patient safety indicators among hospitalized patients.Methods: Cross-sectional study was conducted. Data were extracted from the 2009 National Inpatient Sample. A total of 3,052,268 patient safety indicator-related discharges were identified. Dependent variables were 11 patient safety indicators (PSI) whereas independent variables included race/ethnicity and insurance status. Results:As compared with White patients, African American patients were more likely to experience pressure ulcer, postoperative hemorrhage or hematoma, and post-operative pulmonary embolism (PE) or deep vein thrombosis (DVE); Asian/Pacific Islander patients were more likely to experience pressure ulcer, post-operative PE or DVT, and two obstetric care PSIs; whereas Hispanic/Latino patients were more likely to experience post-operative physiometabolic derangement and accidental puncture/ laceration. As compared with patients with private insurance, Medicaid patients were more likely to experience pressure ulcer, post-operative physiological metabolic derangement, post-operative PE or DVT, post-operative respiratory failure, post-operative wound dehiscence, and death among surgeries. However, both obstetric care PSIs showed that African Americans, Hispanics, and uninsured patients were less likely to incur them in comparison with their respective counterparts. Furthermore, strong interactive effects between African American and Medicaid on PSIs were detected. Conclusions:Although mixed findings in disparities in PSIs were observed in our study, Asian/Pacific Islander patients and Medicaid patients seem to be the most vulnerable. Further, interactive effects between African American and Medicaid indicate that poverty may be a key factor related to disparities in health care. Future research is merited to identify underlying factors that are related to PSIs among Asian/Pacific Islander patients. Strategies are needed to improve PSIs among Medicaid patients, especially during the current Medicaid program expansion due to the implementation of the Affordable Care Act.

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Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care

Cited by 577 publications

References 20 publications

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

A Brief, Multifaceted, Generic Intervention to Improve Blood Pressure Control and Reduce Disparities Had Little Effect

Preventive services in veterans in relation to disability

Racial and Insurance Status Disparities in Patient Safety Indicators among Hospitalized Patients

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