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Previous Volume 348:2218-2227 May 29, 2003 Number 22 Next

	Full Text PDF PDA Full Text Editorial by Jencks, S. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background In the mid-1990s, the Department of Veterans Affairs (VA) health care system initiated a systemwide reengineering to, among other things, improve its quality of care. We sought to determine the subsequent change in the quality of health care and to compare the quality with that of the Medicare fee-for-service program.

Methods Using data from an ongoing performance-evaluation program in the VA, we evaluated the quality of preventive, acute, and chronic care. We assessed the change in quality-of-care indicators from 1994 (before reengineering) through 2000 and compared the quality of care with that afforded by the Medicare fee-for-service system, using the same indicators of quality.

Results In fiscal year 2000, throughout the VA system, the percentage of patients receiving appropriate care was 90 percent or greater for 9 of 17 quality-of-care indicators and exceeded 70 percent for 13 of 17 indicators. There were statistically significant improvements in quality from 1994–1995 through 2000 for all nine indicators that were collected in all years. As compared with the Medicare fee-for-service program, the VA performed significantly better on all 11 similar quality indicators for the period from 1997 through 1999. In 2000, the VA outperformed Medicare on 12 of 13 indicators.

Conclusions The quality of care in the VA health care system substantially improved after the implementation of a systemwide reengineering and, during the period from 1997 through 2000, was significantly better than that in the Medicare fee-for-service program. These data suggest that the quality-improvement initiatives adopted by the VA in the mid-1990s were effective.

Source Information

From the Office of Quality and Performance, Veterans Health Administration, Washington, D.C. (A.K.J., J.B.P.); the Division of General Internal Medicine, San Francisco Veterans Affairs Medical Center, San Francisco (A.K.J.); the Division of General Internal Medicine, Brigham and Women's Hospital, Boston (A.K.J.); the National Quality Forum, Washington, D.C. (K.W.K.); and the Institute for Health Policy Studies, University of California, San Francisco, San Francisco (R.A.D.).

Address reprint requests to Dr. Dudley at the Institute for Health Policy Studies, Box 0936, 333 California St., Suite 265, San Francisco, CA 94118, or at adudley{at}itsa.ucsf.edu.

Full Text of this Article

Related Letters:

The Quality of Care in the Veterans Affairs Health Care System
Arsura E. L., Lewis M., Jha A. K., Perlin J. B., Dudley R. A.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:1093-1094, Sep 11, 2003. Correspondence

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