Veterans' hospitals in U.S. are often better than nearby alternatives

U.S. Veterans Administration (VA) hospitals may provide better quality care than other hospitals in many American communities, a U.S. study suggests.

Researchers looked at 121 regional health care markets with at least one VA hospital and one non-VA facility. Altogether they assessed 135 VA hospitals and 2,988 non-VA hospitals using Hospital Compare, a public database that ranks hospitals on quality measures like mortality rates for common diseases and preventable complications.

Across all regions, the VA was consistently better than non-VA facilities on almost every quality measure, the research team reports in Annals of Internal Medicine.

VA hospitals provided the best care in most regions for at least nine of 15 quality measures, and above-average care for 14 measures.

"Assuming the measures are calculated in a fair and comparable way, our findings suggest that, for these measures, VA quality is at least as good as non-VA quality and often better," said study co-author Dr. William Weeks of the Dartmouth Institute for Health Policy and Clinical Practice in Lebanon, New Hampshire.

While earlier nationwide studies found the VA stacks up well against other hospitals, the current analysis might help patients decide where to seek care in the communities where they live, Weeks said by email.

"The hope is that veterans might use publicly available resources like the Hospital Compare data that we used to make informed choices about where to get care," Weeks added.

More often than not, the VA had the best quality care in local hospital markets for chronic obstructive pulmonary disorder (COPD). The VA was the best or above average in most markets for treating heart attacks, heart failure and pneumonia, the study found.

The VA also ranked best in local markets at least half the time for measures including death rates among patients with serious complications after surgery; collapsed lung due to medical treatment; broken hip from a fall after surgery; and bloodstream infections after surgery.

The findings suggest that outsourcing veterans' care to non-VA hospitals solely for patient convenience should be reconsidered, particularly in regions where nearby hospitals don't achieve quality scores that are better than the VA, the authors conclude.

Limitations of the study include the use of regional hospital markets defined not by Hospital Compare, but by the Dartmouth Atlas of Health Care. Another drawback is that VA and non-VA hospitals may have reported data to Hospital Compare using different methods, the researchers note.

Hospital Compare is also an imperfect tool for examining hospital quality, said Dr. Ryan Merkow of the Feinberg School of Medicine Northwestern University in Chicago.

"This study reports how VA and Non-VA hospitals that are located in the same regional market compare, based on Hospital Compare data which has significant limitations," Merkow, who wasn't involved in the study, said by email.

"No conclusions can be made about care outside of the measures reported," Merkow added.

There is, however, a body of evidence dating back more than a decade that has generally found VA hospitals provide higher quality care than non-VA facilities, said Dr. Anupam Jena of Harvard Medical School and Massachusetts General Hospital in Boston.

"Part of this may be that non-VA care costs patients money to use whereas that is not true of the VA, and we know that cost of care can be a barrier to access," Jena, who wasn't involved in the study, said by email.

"Part of this may also come from the early adoption of electronic health records by the VA and the fact that it truly integrates both hospital, outpatient, and pharmacy care," Jena added.

SOURCE: Annals of Internal Medicine, online December 10, 2018.