VA scores favorably in RAND health care study

The embattled Veterans Affairs health care system generally performs better than or similar to other health care systems for providing safe and effective care to patients, according to a new RAND Corporation study.

The VA, under fire for long wait times, often (but not always) performs better than or similarly to other systems of care for patient safety and effectiveness of care. More studies are needed, particularly looking at timeliness, equity, efficiency, and patient "centeredness." the report concludes.

Analyzing 10 years of study, researchers found that the VA generally delivered care that was better or equal in quality to other health care systems.

There were some exceptions, and critics are likely to pounce on those as Congress weighs what changes might be needed for the nation's largest integrated health care system.

For instance, researchers say there were few studies done to evaluate equity, efficiency and patient-centeredness, and that the quality of the available studies varies.

The findings have been published in the Journal of General Internal Medicine.

"We found that the overall quality of care in the VA health system compares favorably to other segments of the U.S. health care system," Dr. Courtney Gidengil, co-author of the study and a physician scientist at RAND, a nonprofit research organization, said in a statement accompanying the report.

RAND researchers searched medical literature to identify research published between January 2005 and January 2015 about the quality of care at VA health facilities compared with non-VA health facilities.

Twenty-two of the 34 studies on safety and 20 of the 24 studies focusing on effectiveness showed that VA facitilies provide the same, if not better, care. These studies took into account safety measures and best practices intended to avoid the illness, injury or death of patients, such as post-surgical complications.

Surgery patients in the VA system and VA nursing homes patients had death rates similar to patients in other health systems, according to the report.

Rates of surgical complications and the availability of services had the least favorable results, but these results were mixed rather than consistently poor, the report said.

The report said VA facilities had similar or superior quality to non-VA facilities when compared for preventive care, recommended care and end-of-life care, as well as for managing medications. Outpatient care, for instance, generally rated higher in VA facilities for diabetes care and screening tests related to heart disease and cancer.

During the last five years, no stark trends can be observed about whether performance in the VA is better or worse than in other health settings, the report concluded.

While the studies included in the RAND analysis attempted to adjust for differences between veteran and nonveteran populations wherever possible, some differences between the two populations still may remain.

"Comparing the VA to other health care settings can be difficult because the VA has a patient population that is different from most other settings, with patients who may be sicker," Gidengil said in the statement.

"But it's important to do more of this work in the future so we can better understand the quality of care the VA provides."