Variations In Efficiency And The Relationship To Quality Of Care In The Veterans Health System

Abstract

There is widespread belief that the US health care system could realize significant improvements in efficiency, savings, and patient outcomes if care were provided in a more integrated and accountable way. We examined efficiency and its relationship to quality of care for medical centers run by the Veterans Health Administration of the Department of Veterans Affairs (VA), a national, vertically integrated health care system that is accountable for a large patient population. After devising a statistical model to indicate efficiency, we found that VA medical centers were highly efficient. We also found only modest variation in the level of efficiency and cost across VA medical centers, and a positive correlation overall between greater efficiency and higher inpatient quality. These findings for VA medical centers suggest that efforts to drive integration and accountability in other parts of the US health care system might have important payoffs in reducing variations in cost without sacrificing quality. Policy makers should focus on what aspects of certain VA medical centers allow them to provide better care at lower costs and consider policies that incentivize other providers, both within and outside the VA, to adopt these practices.

Engagement in research: an innovative three-stage review of the benefits for health-care performance

“…As reported in numerous papers, the VHA's national performance on a range of measures improved dramatically in succeeding years, generally meeting or exceeding performance in other national health systems. 76,[189][190][191][192][193][194] So what were the characteristics of this performance management and measurement system that led to this success, and is it legitimate to see it as an example of an organisational mechanism through which research engagement leads to improved performance?…”

“…8 research and its outputs. 76,[189][190][191][192][193] However, at the organisational level, as at other levels, engagement in research operates through a variety of mechanisms and is only one of many influences on performance. Disaggregating how these mechanisms operate in complex systems is not straightforward.…”

Opportunities to Enhance Value-Related Research in the U.S. Department of Veterans Affairs

“…The VA has a well-established electronic medical record, and utilizes these data to generate dashboards of quality metrics, such as hospital-acquired infections, risk-adjusted mortality, or efficiency. 26,27 None of the dashboards provide explicit value metrics (i.e., measures that synthesize information about [incremental] quality/outcomes and costs). Metrics that identify value for specific types of care (e.g., highvalue diabetes care) are needed.…”

Facility-Level Variation in Hospitalization, Mortality, and Costs in the 30 Days After Percutaneous Coronary Intervention

“…11 The financial management system of the VA (Decision Support System) is an accounting method to track use and costs rather than charges and payments. The Decision Support System uses an "activity-based costing" approach, similar to microcosting, and assigns costs based on relative value units for products of care using automated data.…”

“…13 This system is the primary data source that informs VA Health Care operation budgetary requests and serves as the source of cost data for the present analyses. 11,14 The VA Clinical Assessment, Reporting, and Tracking (CART) Program is the national clinical quality program for all VA cardiac catheterization laboratories. The CART Program uses a software application that is embedded within the VA electronic health record to collect patient and procedural data at the point of care for all cardiac catheterizations and PCIs performed in the VA. [15][16][17] These data are linked to the VA electronic health record, allowing linkage to longitudinal data on mortality, hospitalizations, outpatient visits, medications, and laboratory results.…”