For years, the Department of Veterans Affairs medical system has been criticized for providing inferior care to the nation's veterans. In response, the VA has been trying to institute reforms aimed at improving the quality of a host of medical services. Now, a new study indicates that at least for one important disease, the changes appear to have paid off.
The study found that the quality of care that veterans receive for diabetes from five VA systems across the country is superior to that provided by some of the best private managed-care organizations in those regions.
"This isn't about managed care being bad -- this is about the VA doing exceptionally well," said Eve Kerr, a research scientist at the VA Ann Arbor Health Care System and an assistant professor at the University of Michigan Medical School, who led the study.
Sheldon Greenfield, a professor of medicine at the University of California at Irvine, who wrote a commentary that accompanied the study in the Aug. 17 issue of the Annals of Internal Medicine, agreed.
"They instituted a lot of changes within the VA, and it's paid off," Greenfield said in a telephone interview. "They've really instituted some terrific changes."
To try to raise the quality of care, Kerr said, the VA took a number of steps that leading experts have been recommending for years that all providers in the nation's medical system adopt to ensure optimal care, such as computerizing medical records, setting uniform standards for treatment and closely monitoring the delivery of care and patient outcomes.
To try to evaluate the impact at the VA, Kerr and her colleagues focused on diabetes because it is a common, chronic condition that is often difficult to manage and is becoming increasingly common in the United States.
The researchers examined the medical records of 1,295 patients receiving care at VA systems in Michigan, Indiana, Texas, New York and California, and 6,920 similar patients receiving care at eight managed-care organizations in the same areas.
The VA patients tended to be much more likely to get the recommended care, and to have their cholesterol and blood sugar levels kept under better control, the researchers found.
For example, 93 percent of the VA patients had an annual blood test they needed, compared with 83 percent of the managed-care patients. Seventy-five percent of the VA patients were counseled about aspirin use, compared with 49 percent of the managed-care patients. Ninety-one percent of the VA patients had an annual eye exam, compared with 75 percent of the managed-care patients, and 98 percent of the VA patients had an annual foot exam, compared with 84 percent of the managed-care patients.
"I think there's a few encouraging points that we can take away from this study," Kerr said. "One is that a nationally funded health care system can provide excellent quality of care, and the way care is delivered can make a difference."
But in addition to being good news for veterans, the findings have broader implications, Kerr said. They suggest that health care systems in general can make changes that positively affect patients.
"We can change the way an organization delivers care, and those changes can make a difference overall," she said.
Greenfield agreed, saying: "It's very positive, both for the VA and for the rest of the country. It shows that system changes that use measures and goals can have an impact, even on chronic diseases that can be very difficult to manage. The VA seems to have accomplished these changes without too much of the negative side effects."
But Greenfield was cautious about how many of the changes could easily be adopted by other organizations.
"Not all of it is translatable, but components of it could be," Greenfield said. "It could be a model."
The results of the study were welcomed by the VA.
"We're obviously very proud and pleased," said Jonathan Perlin, acting undersecretary for health at the VA. "This study validates the transformation of the VA health care system."
The results echo other findings that show the VA system has dramatically improved a wide variety of care for patients, he said. "All of those areas are measured, and the improvement has been equally dramatic," Perlin said. "We're pleased to know these evidence-based care processes translate directly into improved outcomes for veterans."