Effect of the transformation of the Veterans Affairs health care system on the quality of care

Jha, Alok; Perlin, Johnathan B; Kizer, Kenneth W.; Dudley, R. Adams

doi:10.1016/j.accreview.2003.08.066

Cited by 196 publications

(253 citation statements)

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“…We defined quality of care using the Institute of Medicine's (IOM) definition, which is Bthe degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge.^1 1 Given the existence of a recent systematic review on the quality of health care delivered in VA versus comparable non-VA settings, we chose to explicitly build upon and expand this work. 7 We use consistent methods, including the same search terms (Online Appendix) and database (MEDLINE).…”

Section: Search Strategymentioning

confidence: 99%

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

et al. 2016

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Section: Search Strategymentioning

confidence: 99%

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

et al. 2016

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“…21 Additionally, since the mid-1990s the VHA has made demonstrable advances in improving the quality of preventive care, including CRCS. [22][23][24] With 80% of eligible patients receiving guideline-concordant CRCS, 25 CRCS rates in the VHA are notably higher than the national average of less than 60%. 26 Because quality improvement has been associated with reductions in disparities, 27,28 it is plausible that racial disparities in adherence to CRCS could be nonexistent in the VHA.…”

mentioning

confidence: 99%

Presence and Correlates of Racial Disparities in Adherence to Colorectal Cancer Screening Guidelines

et al. 2010

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OBJECTIVES:We examined the presence and correlates of Black/White racial disparities in adherence to guidelines for colorectal cancer screening (CRCS). METHODS:The sample included 328 Black and 1827 White patients age 50-75 from 24 VA medical facilities who responded to a mailed survey with phone follow-up (response rate: 73% for Blacks and 89% for Whites). CRCS adherence and race were obtained through surveys and supplemented with administrative data. Logistic regressions estimated the contribution of demographic, health, cognitive, and environmental factors to racial disparities in adherence to CRCS guidelines. RESULTS: In unadjusted analyses, Blacks had slightly lower rates of adherence to CRCS guidelines than Whites (72% versus 77%, p<0.05). This racial disparity in CRCS adherence was explained by race differences in demographic, health, and environmental factors but not by cognitive factors. Tests for interactions revealed that the association of race with adherence varied significantly across levels of income, education, and marital status. In particular, among those who were married with higher levels of education, CRCS adherence was significantly higher for Whites; whereas among those who were unmarried, with low levels of education, adherence was significantly higher for Blacks. CONCLUSION: We found that disparities in CRCS are greatly attenuated in the VA system and both Whites and Blacks have substantially higher rates of CRCS than the national average. These results point to the success of the VA at implementing CRCS system-wide. Our findings also suggest additional initiatives may be needed for unmarried low income white men and higher income black men. These disparities are partially attributable to lower rates of CRC screening (CRCS) by Blacks, 3-5 which has been shown to significantly reduce CRC mortality. [6][7][8][9] To understand what factors contribute to CRCS adherence, researchers have drawn on health behavior theories and have examined such factors as cognitions about screening, social and medical environmental factors, and demographic and health-related factors. [10][11][12] Few studies, however, have explored the extent to which racial disparities in adherence to CRCS are a function of these underlying factors, leaving unanswered questions about the best approaches to promote screening among populations with greater disease burden. [13][14][15][16][17][18][19][20] This study contributes to the broader literature on race differences in CRCS by examining the relative contribution of demographic and health factors, cognitive factors, and environmental factors to racial disparities in CRCS in a nationally representative survey of Veterans Health Affairs (VHA) patients aged 50-75.The VHA is a particularly interesting system within which to examine racial disparities in CRCS because it provides equal access to care to all qualifying veterans, and mandates that all patients be assigned to a primary care provider, both of which diminish barriers to screening that might disproportionally affect r...

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“…The VA has had a fully implemented EMR for more than a decade, and has seen dramatic improvements in clinical quality attributed to its functionality. 21 The Institute of Medicine has also independently rated VA's EMR as among the best in the U.S. (IOM 2002). Yet, three of the top four challenges reported by VA PC directors nationally were focused on clinical informatics, with almost three out of four reporting clinical informatics as a moderate-extreme challenge across facility types, sizes, regions, and urban/ rural locations.…”

Section: Discussionmentioning

confidence: 99%

“…Not surprisingly, pilot teams for PACT have given particular emphasis on improving access. 36 Substantial gains in VA preventive care delivery predated VA's PACT initiative, 21 reflecting prior investments in PC, at least in part. 37 We were therefore not entirely surprised that VA PC directors reported the least amount of frustration with preventive care delivery, and even then, only with CRC screening, which requires iterative steps and specialty collaboration.…”

Section: Discussionmentioning

confidence: 99%