Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care

1. Effect of the Transformation of the Veterans Affairs Health Care System on the Quality of Care Citation: Jha AK et al. New England Journal of Medicine, 2003; 348(22):2218-27 Ashish K. Jha, MD Jonathan B. Perlin, MD PHD Kenneth W. Kizer, MD MPH R. Adams Dudley, MD MBA Presented at: Is There a Future for Integrated Care Systems in the Consumer Era? AcademyHealth Annual Research Meeting June 6, 2004

2. VA Performance in Preventive Services

3. VA Performance in Chronic Disease Management

4. VA Performance in Inpatient Care

5. VA versus Medicare P-value for all comparison < 0.01

6. VA versus Medicare P-value for all comparison < 0.01

7. Discussion • VA Transformation • Large gains in quality • Due to re-engineering efforts • Comparison to Medicare • VA quality better than Medicare now, for nearly all measures • BUT USED TO BE WORSE! • Implies • Re-engineering and rapid improvement may be more feasible in an integrated delivery system • ON THE OTHER HAND: VA’s poor initial performance shows an IDS can go badly wrong if neglected • It’s not enough just to integrate; commitment to high quality—and likely performance measurement and accountability—are key

8. Another Point to Note • The VA-Medicare comparisons are only recently feasible, because our performance measurement tools have improved recently--especially in the domains of chronic and acute (vs. preventive) care • These domains are more likely to show benefits from integration, so differences between IDSs and other systems may become more visible over time