April 26 (UPI) — Veterans receiving care in the Veterans Administration healthcare system receive inpatient and outpatient treatment similar to other providers, according to a RAND Corporation study.
But the researchers found a high variation in quality across individual facilities. Their findings were published Thursday in the Journal of General Internal Medicine.
“The variation among VA health facilities shows that veterans in some areas are not receiving the same high-quality care that other VA facilities are able to provide,” Carrie Farmer, a study co-author and a senior policy researcher at RAND, said in a press release.
Congress, veterans’ groups and President Donald Trump have expressed concerns about timely access and quality of care in the VA system. Trump has suggested that the system should be privatized or offer more options on non-VA services.
Last August, Trump allocated $2.1 billion to expand a program to ensure care for veterans who live in rural areas, far from VA hospitals or clinics. Another $1.8 billion was allocated to increase staff, improve existing VA facilities and open 28 new VA clinics.
The Veterans Health Administration operates the nation’s largest integrated health system, providing care at 1,240 facilities, including 170 VA medical centers and 1,061 outpatient sites. More than 9 million veterans are enrolled in the VA healthcare program.
Services include surgery, critical care, mental health, routine exams, orthopedics, pharmacy, radiology, physical therapy, dental and vision care.
In a key aspect, the researchers noted the “quality measures focus on care provided for veterans who have successfully accessed the system but do not examine the degree to which VA may be able to facilitate veterans enrolling or gaining access to care in the VA system in a timely manner. “
RAND researchers examined several national surveys during 2013 and 2014, including Healthcare Effectiveness Data and Information Set, and the Survey of Healthcare Experiences of Veterans.
Researchers identified three non-VA hospitals that had similar characteristics to each of the 135 VA facilities, including geographic location and the population size. In all, 402 non-VA hospitals were studied.
In their analysis, they examined six measures of inpatient safety, three measures of inpatient mortality and 12 measures of the effectiveness of inpatient care.
The VA hospitals were significantly worse on three re-admission measures and two effectiveness measures. They found VA inpatient performance was significantly lower on the patient experience measure for pain management but significantly higher on patient experiences for management of care transitions.
The VA facilities outperformed Medicare HMOs on 14 of the 16 measures of effectiveness. The smallest difference between the VA and Medicare HMOs was in the rate of antidepressant medication management during an acute phase. The largest difference was in eye examinations for patients with diabetes.
Comparing VA and Medicaid HMOs, the smallest difference was in the rate of ongoing beta-blocker treatment after an acute heart attack. The largest difference was eye examinations for patients with diabetes.
But researchers found a 50-percentage-point difference in performance between the lowest and highest performing VA facilities during 2014 on the rate of beta blocker treatment at least six months after discharge from an acute heart attack.
The researchers noted that veterans may differ from patients in non-VA settings in terms of demographic characteristics and clinical characteristics. “However, the effectiveness measures in the study focus on care recommended for all eligible patients; therefore, all patients, regardless of characteristics, should receive the recommended care, and differing patient characteristics should not bias those comparisons.” the researchers wrote.
Also it noted they relied on limited number of variables of the groups of hospitals.