Background In the mid-1990s, the Department of Veterans Affairs(VA) health care system initiated a systemwide reengineeringto, among other things, improve its quality of care. We soughtto determine the subsequent change in the quality of healthcare and to compare the quality with that of the Medicare fee-for-serviceprogram.
Methods Using data from an ongoing performance-evaluation programin the VA, we evaluated the quality of preventive, acute, andchronic care. We assessed the change in quality-of-care indicatorsfrom 1994 (before reengineering) through 2000 and compared thequality of care with that afforded by the Medicare fee-for-servicesystem, using the same indicators of quality.
Results In fiscal year 2000, throughout the VA system, the percentageof patients receiving appropriate care was 90 percent or greaterfor 9 of 17 quality-of-care indicators and exceeded 70 percentfor 13 of 17 indicators. There were statistically significantimprovements in quality from 1994–1995 through 2000 forall nine indicators that were collected in all years. As comparedwith the Medicare fee-for-service program, the VA performedsignificantly better on all 11 similar quality indicators forthe period from 1997 through 1999. In 2000, the VA outperformedMedicare on 12 of 13 indicators.
Conclusions The quality of care in the VA health care systemsubstantially improved after the implementation of a systemwidereengineering and, during the period from 1997 through 2000,was significantly better than that in the Medicare fee-for-serviceprogram. These data suggest that the quality-improvement initiativesadopted 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.
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