VA may top other hospitals in quality but not patient satisfaction

(Reuters Health) - Veterans Affairs (VA) hospitals in the U.S. may deliver higher quality care than other medical centers but still get lower marks on patient satisfaction, a new study suggests.

Researchers examined data for 129 VA and 4,010 non-VA hospitals nationwide and found the VA had lower rates of six complications tied to quality: pressure ulcers, deaths of surgical patients with serious treatable conditions, care-related lung injuries, clots in the vein in surgical patients, catheter-related bloodstream infections, post-operative bloodstream infections and post-operative surgical wound ruptures. Rates of other complications tied to quality were similar at VA and non-VA hospitals.

For some common medical problems, the VA also had lower mortality rates and lower rates of repeat hospitalizations than other hospitals, the study found.

But when it came to several measures of patient satisfaction like doctors’ and nurses’ communication skills and pain management, the VA lagged behind.

“The VA certainly looks good on many of these measures, but they definitely have room for improvement regarding the patient experience,” said senior study author Dr. Karl Bilimoria, director of the Surgical Outcomes and Quality Improvement Center at Northwestern University Feinberg School of Medicine in Chicago.

“Patients at VA hospitals were less likely to recommend VA hospitals to friends or family than patients at non-VA hospitals,” Bilimoria said by email.

The researchers note in JAMA Internal Medicine that the U.S. Centers for Medicare and Medicaid Services (CMS) recently updated Hospital Compare, a website that helps patients choose where to get care, to include VA hospitals.

For the current study, the study team examined data from Hospital Compare for 2012 to 2015 and from the American Hospital Association’s 2014 annual survey.

Non-VA hospitals did better on four of nine measures of behavioral health quality including screening for alcohol and tobacco use and developing clear plans for care after patients leave the hospital, the study found.

The findings might reflect a decades-long investment in quality improvement and care coordination at the VA and efforts to document outcomes for patients with multiple complex medical conditions, the researchers note.

It’s possible some of these quality measures don’t necessarily reflect the true quality of patient care, the authors also point out.

“The VA has had some excellent initiatives to improve quality in a number of areas, particularly in surgery through the landmark quality assessment program, NSQIP,” Bilimoria said. “However, the outcome measures CMS has reported here are flawed and are not that useful or valid, so patients are still left without valid information about whether VAs truly have better or worse outcomes than non-VA hospitals.”

Still, the findings mirror results from other research demonstrating that VA hospitals in general have equal or better outcomes on certain quality measures, said Dr. Vineet Arora, a researcher at the University of Chicago who wasn’t involved in the study.

“What is new here is that the patient experience and behavioral health measure comparisons were less favorable for VA hospitals,” Arora said by email.

The patient experience scores in the current study appear to be consistent with reports of treatment delays at the VA in recent years, said Dr. Anupam Jena, a health policy researcher at Harvard Medical School in Boston who also wasn’t involved in the analysis.

But because the study wasn’t a controlled experiment designed to test what happens when similar patients are randomly sent to VA or non-VA hospitals, it’s hard to rule out the possibility that any differences might be due to who gets treated where, Jena said by email.

“The mortality differences between the VA and non-VA hospitals are quite large, larger than I would expect. That makes me wonder whether similar patients are being compared between the two sets of hospitals,” Jena noted.

“That said, I am sure there are lessons that other hospitals can learn from the VA and vice versa,” Jena added. “From a patient perspective, the study certainly does not raise red flags about specific groups of hospitals.”

SOURCE: JAMA Internal Medicine, online April 17, 2017.