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VA Patient Care Varies Widely Across the System — Here’s Why That Matters



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The Wall Street Journal has a handy table that shows that the big differences in health-care outcomes at various Department of Veterans Affairs hospitals. Based on the Journal’s calculations, Phoenix is one of the worst VA hospitals in the country while Boston is one of the best.

Here is what the difference in quality of care means for veterans being treated in the different hospitals:

The rate of potentially lethal bloodstream infections from central-intravenous lines was more than 11 times as high among patients at the Phoenix facility than it was at top VA hospitals, data from the year ended March 31, 2014, show.

Those infections, called sepsis, can quickly cause multiple organ failure and kill an otherwise relatively healthy patient within days or even hours. The data don’t show what percentage of patients died as a result.

Among patients admitted to the hospital for acute care, the Phoenix VA Health Care System had a 32% higher 30-day death rate than did the top-performing VA hospitals, a finding flagged as statistically significant by the agency’s medical analysts.

By contrast, Boston’s VA hospital, considered among the system’s best, had a central-IV-line, bloodstream-infection rate that was 63% below the average of the top-performing hospitals. It also had a slightly better-than-average, 30-day mortality rate for acute care. …

In other examples of variations in care, the Atlanta VA Medical Center, a two-star hospital for quality, has more than three times the rate of central-IV infections than the average of five-star VA hospitals. Houston’s VA hospital, ranked as a two-star hospital, had a 47% higher acute-care mortality rate than the five-star hospital rate.

Some disparity of care between hospitals is to be expected, but in theory it shouldn’t happen to this degree in a national, integrated delivery system like the VA. The variations also mean that any one-size-fits-all solution that Congress may come up with won’t really be sensible (as, of course, is usually the case).

Here is the VA’s response to the Wall Street Journal story:

The VA spokesman did not identify specific hospital centers that might be subject to higher scrutiny. His full statement is below:

“There is some statistical variation that causes a spread among medical centers, but in some cases there are real differences or variability among our medical centers on some measures.  In order to tell the difference between random variation and real differences, VHA looks for facilities that are consistently high or low over time on a variety of measures or specific key measures.  Some measures themselves are subject to more variation than others.  VHA has a formal process by which senior leadership reviews performance data for all facilities and networks on a regular basis.  Medical centers that display consistently low scores on particular measures are identified and senior VHA leadership works with the facility to better understand the reasons for low performance and to help foster improvement. Those facilities that fail to demonstrate improvement are subject to increasing degrees of scrutiny and oversight by VHA leadership.”

The translation of this bureaucrat-speak about measurement, process, and performance reviews: Veterans in need of care aren’t done waiting. 



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