Sierra Matula

Systematic Review: Comparison of the Quality of Medical Care in Veterans Affairs and Non-veterans Affairs Settings

Background:The Veterans Health Administration, the nations largest integrated delivery system, launched an organizational transformation in the mid 1990s to improve the quality of its care. Purpose:To synthesize the evidence comparing the quality of medical and other nonsurgical care in Veterans Affairs (VA) and non-VA settings. Data Sources:MEDLINE database and bibliographies of retrieved studies. Study Selection:Studies comparing the technical quality of nonsurgical care in VA and US non-VA settings published between 1990 and August 2009. Data Extraction:Two physicians independently reviewed 175 unique studies identified using the search strategy and abstracted data related to 6 domains of study quality. Data Synthesis:Thirty-six studies met the inclusion criteria. All 9 general comparative studies showed greater adherence to accepted processes of care or better health outcomes in the VA compared with care delivered outside the VA. Five studies of mortality following an acute coronary event found no clear survival differences between VA and non-VA settings. Three studies of care processes after an acute myocardial infarction found greater rates of evidence-based drug therapy in VA, and 1 found lower use of clinically-appropriate angiography in the VA. Three studies of diabetes care processes demonstrated a performance advantage for the VA. Studies of hospital mortality found similar risk-adjusted mortality rates in VA and non-VA hospitals. Limitations:Most studies used decade-old data, assessed self-reported service use, or included only a few VA or non-VA sites. Conclusions:Studies that assessed recommended processes of care almost always demonstrated that the VA performed better than non-VA comparison groups. Studies that assessed risk-adjusted mortality generally found similar rates for patients in VA and non-VA settings.

Comparisons of Quality of Surgical Care between the US Department of Veterans Affairs and the Private Sector

The Department of Veterans Affairs (VA) is the largestintegrated health system in the United States. Since itsestablishment in 1930, the VA has provided medical andsurgicalcaretoveteransofUSmilitaryservice.VAservicesare provided primarily by salaried federal employees work-ing in government-operated facilities.

Quality of care in surgical oncology.

BACKGROUND High-quality health care is safe, effective, efficient, timely, patient-centered, and equitable. A current focus on quality assessment and improvement in oncology care, specifically in surgical oncology, is aimed toward providing optimal health services that consistently fulfill these elements for cancer patients. METHODS In surgical oncology, outcomes have historically focused on perioperative morbidity and mortality. To assess care metrics in the United States, we review structural and process measures of quality care in surgical oncology. RESULTS Most quality metrics in surgical oncology pertain to structural measures of care such as accreditation, procedure volumes, provider specialization, and multidisciplinary teams. Process measures, such as surgical technique, are also important but are not easily quantified. CONCLUSIONS Policy implications of quality metrics in surgical oncology include formal regionalization of care, changes in payment structures, and public reporting. More comprehensive assessments of outcomes are gaining traction in the field of surgical oncology; this shift in focus to the patients perspective will enhance the quality of care delivered by surgical oncologists.

Operation Access: a proven model for providing volunteer surgical services to the uninsured in the United States.

BACKGROUND Numerous studies have shown that patients without insurance lack coordinated health care and access to surgical procedures. Operation Access (OA) has coordinated uncompensated, low-risk outpatient surgical and specialty services to the uninsured in a volunteer setting for 15 years. Our objective was to evaluate the quality of outpatient surgical care provided by OA volunteers. STUDY DESIGN Retrospective cohort study using data from OAs secure database to evaluate the quality of care provided to all patients eligible for OA services from 1994 through 2008. Primary outcomes included quality of care as measured by the Institute of Medicines six quality aims, ie, safety, efficiency, effectiveness, timeliness, patient-centered care, and equity. RESULTS Six-thousand five-hundred and forty-two patients were referred to OA during the past 15 years; 83.4% met eligibility criteria. Of these, 3,518 unduplicated patients received 3,098 surgical, endoscopic, and minor procedures. Only 12 of 1,880 surgical patients experienced a complication requiring hospitalization. Patient care was efficient, with a 95.3% overall compliance rate; approximately

Comparison of Quality of Care in VA and Non-VA Settings

7.56 of services were provided for every dollar of philanthropic support. OAs strong emphasis on case management, focus on continuity of care, and patient-selection criteria contributed to the organizations provision of safe, efficient, effective, timely, and patient-centered care. A higher percentage of Latinos and a lower percentage of African Americans relative to the geographic demographics received OA services. CONCLUSIONS A volunteer program providing low-risk outpatient operations using the OA model delivers safe, efficient, effective, timely, and patient-centered care.