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Previous Volume 343:1934-1941 December 28, 2000 Number 26 Next

	Full Text PDF Editorial by Fihn, S. D. Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited PubMed Citation

ABSTRACT

Background Some have the opinion that patients cared for in Veterans Health Administration (VHA) hospitals receive care of poorer quality than those cared for in non-VHA institutions. To assess the quality of care in VHA hospitals, we compared the outcome of acute myocardial infarction among patients in VHA and non-VHA institutions while controlling for potential confounders, including coexisting conditions and severity of illness.

Methods We studied 2486 veterans discharged from 81 VHA hospitals and 29,249 Medicare patients discharged from 1530 non-VHA hospitals, restricting our samples to men at least 65 years of age who were discharged with confirmed acute myocardial infarction. We compared coexisting conditions, severity of illness, and 30-day and 1-year mortality in the two samples.

Results VHA patients were significantly more likely than Medicare patients to have a recorded history of hypertension (64.3 percent vs. 57.3 percent), chronic obstructive pulmonary disease or asthma (30.9 percent vs. 23.5 percent), diabetes (34.8 percent vs. 29.0 percent), stroke (20.4 percent vs. 14.2 percent), or dementia (7.2 percent vs. 4.8 percent) (P<0.001 for all comparisons). According to both multivariate logistic regression and an analysis using 2265 matched pairs of VHA and Medicare patients, there were no significant differences in 30-day or 1-year mortality. The matched-pairs analysis found that the difference in mortality at 30 days (the mortality rate among Medicare patients minus the mortality rate among VHA patients), averaged over the 5-year age groups, was –0.8 percent (95 percent confidence interval, –2.8 to 1.3), and the difference in mortality at 1 year was –1.3 percent (95 percent confidence interval, –3.9 to 1.3).

Conclusions VHA patients had more coexisting conditions than Medicare patients. Nevertheless, we found no significant difference in mortality between VHA and Medicare patients, a result that suggests a similar quality of care for acute myocardial infarction.

Source Information

From the Houston Center for Quality of Care and Utilization Studies, Houston Veterans Affairs Medical Center, and the Section for Health Services Research, Department of Medicine, Baylor College of Medicine, Houston (L.A.P.); the Department of Health Care Policy, Harvard Medical School, Boston (S.-L.T.N., B.J.M.); the Institute for Health Policy, Partners Health Care System, and the Department of Medicine, Massachusetts General Hospital, Boston (J.D.); the Department of Biostatistics, Harvard School of Public Health, Boston (S.-L.T.N.); and the Department of Radiology, Brigham and Women's Hospital, Boston (B.J.M.). The views expressed in this article are solely those of the authors and do not necessarily represent those of the Department of Veterans Affairs.

Address reprint requests to Dr. Petersen at Health Services Research and Development (152) (T110), Houston Veterans Affairs Medical Center, 2002 Holcombe Blvd., Houston, TX 77030.

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