Comparing VA and Non-VA Quality of Care: A Systematic Review

O’Hanlon, Claire E; Huang, Christina Y.; Sloss, Elizabeth M.; Price, Rebecca Anhang; Hussey, Peter S.; Farmer, Carrie M.; Gidengil, Courtney A.

doi:10.1007/s11606-016-3775-2

Cited by 134 publications

(114 citation statements)

References 91 publications

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“…In the Department of Veterans Affairs, quality measures are set by central leadership for implementation in over 160 medical centers. While quality of mental health care in the Department has been widely documented, regional variations in processes and outcomes of care are common [82][83][84][85][86] . Hence, while regional service directors are ultimately responsible for improving quality, the Department has launched national initiatives to improve quality of care and reduce disparities in mental health care, notably through the implementation of the Uniform Mental Health Services Handbook 87 and the deployment of mental health care managers in primary care settings to promote integrated care.…”

Section: Innovations In Mental Health Care Quality Measurement and Immentioning

confidence: 99%

Measuring and improving the quality of mental health care: a global perspective

et al. 2018

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Mental disorders are common worldwide, yet the quality of care for these disorders has not increased to the same extent as that for physical conditions. In this paper, we present a framework for promoting quality measurement as a tool for improving quality of mental health care. We identify key barriers to this effort, including lack of standardized information technology-based data sources, limited scientific evidence for mental health quality measures, lack of provider training and support, and cultural barriers to integrating mental health care within general health environments. We describe several innovations that are underway worldwide which can mitigate these barriers. Based on these experiences, we offer several recommendations for improving quality of mental health care. Health care payers and providers will need a portfolio of validated measures of patient-centered outcomes across a spectrum of conditions. Common data elements will have to be developed and embedded within existing electronic health records and other information technology tools. Mental health outcomes will need to be assessed more routinely, and measurement-based care should become part of the overall culture of the mental health care system. Health care systems will need a valid way to stratify quality measures, in order to address potential gaps among subpopulations and identify groups in most need of quality improvement. Much more attention should be devoted to workforce training in and capacity for quality improvement. The field of mental health quality improvement is a team sport, requiring coordination across different providers, involvement of consumer advocates, and leveraging of resources and incentives from health care payers and systems.

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Section: Innovations In Mental Health Care Quality Measurement and Immentioning

confidence: 99%

Measuring and improving the quality of mental health care: a global perspective

et al. 2018

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“…I believe that parts of the VHA's success were exaggerated (much of what is most important in healthcare is hard to measure accurately), but its transition and accomplishments during this period were inarguably impressive. 2 …”

Section: Loose-tight Leadership/managementmentioning

confidence: 99%

“…However, most of evidence the authors cite comes from national or representative VHA samples and present a very strong scientific case to support their main conclusion-that at least for common performance metrics, the available evidence suggests that the quality and safety measures of the VHA were truly as good as or better than those in the private sector, even top-rated managed care organizations. 2 More remarkably, the VHA had been widely viewed in the 1970s and 1980s as an inefficient safety-net provider at best. Its turnaround in the 1990s under VHA Undersecretary Ken Kizer was one of the most dramatic in healthcare history.…”

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confidence: 99%

“…In this issue of JGIM, O'Hanlon et al present an updated review of the evidence on VHA's quality of care. 2 Given the recent controversies surrounding the VHA, some might find these authors' review difficult to believe. It is certainly true that some of the articles cited could be criticized for potential favorable selection (such as over-sampling academic-affiliated VHA facilities) and that the measurement approaches inside and outside the VHA differed.…”

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confidence: 99%

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Lessons from the Rise—and Fall?—of VA Healthcare

Hayward

2016

J GEN INTERN MED

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A round 2005, freelance journalist Phillip Longman was asked by Fortune magazine to write a feature article about a healthcare organization that was doing everything right. After extensive investigation, he wrote a story about the remarkable transformation of the Veterans Health Administration (VHA), but Fortune found this answer unsatisfactory. So he wrote a book 1 that cited extensive evidence claiming that VHA healthcare was second to none. In this issue of JGIM, O'Hanlon et al. present an updated review of the evidence on VHA's quality of care. 2 Given the recent controversies surrounding the VHA, some might find these authors' review difficult to believe. It is certainly true that some of the articles cited could be criticized for potential favorable selection (such as over-sampling academic-affiliated VHA facilities) and that the measurement approaches inside and outside the VHA differed. However, most of evidence the authors cite comes from national or representative VHA samples and present a very strong scientific case to support their main conclusion-that at least for common performance metrics, the available evidence suggests that the quality and safety measures of the VHA were truly as good as or better than those in the private sector, even top-rated managed care organizations. 2 More remarkably, the VHA had been widely viewed in the 1970s and 1980s as an inefficient safety-net provider at best. Its turnaround in the 1990s under VHA Undersecretary Ken Kizer was one of the most dramatic in healthcare history. How did this happen? Is the controversy over wait times evidence that the VHA has since reverted to old ways? If so, how can the VHA find its way again? LOOSE-TIGHT LEADERSHIP/MANAGEMENTI believe that three organizational changes were particularly important in the VHA's transformation: 1) VHA facilities were divided into manageable (just more than 20) Veterans Integrated Service Networks (VISNs) that had reasonably similar patient populations and healthcare delivery challenges, making comparison of their performance much easier; 2) both resources and decision-making authority were principally distributed to these VISNs, thereby delegating day-to-day decision-making power to those with the most information about their local resources and environments; and 3) each VISN leader was held strictly accountable for success, with success monitored by carefully chosen measures of quality and efficiency. In other words, the VHA Central Office meddled little in day-to-day operations (loose = minimal micromanagement), but held VISNs strictly accountable for central values such as quality and efficiency (tight = strict accountability for performance). Moreover, the VHA Central Office evaluation system was created such that a given VISN's success was not predicated on another's failure. This form of managed competition between VISNs created a cooperative, positive culture of collaborative continuous improvement. Further, when leaders in the field brought strong arguments to the national leaders, the Central Off...

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“…While prevailing political rhetoric is to rail about the quality of care provided by the VA, objective measures have consistently demonstrated that the VA achieves outcomes comparable to or better than those attained in non-VA settings. 4 The implications for the potential health equity and reduction in care disparities from a single-payer system are obvious.…”

mentioning

confidence: 99%

Capsule Commentary on Borrero et al., Unintended Pregnancy and Contraceptive Use among Women Veterans: The ECUUN Study

Jackson

2017

J GEN INTERN MED

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Comparing VA and Non-VA Quality of Care: A Systematic Review

Cited by 134 publications

References 91 publications

Measuring and improving the quality of mental health care: a global perspective

Measuring and improving the quality of mental health care: a global perspective

Lessons from the Rise—and Fall?—of VA Healthcare

Capsule Commentary on Borrero et al., Unintended Pregnancy and Contraceptive Use among Women Veterans: The ECUUN Study

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