Improving Medical Care for Veterans

Review of Veterans Affairs hospital readmission rates shows minor variations in outcomes for VA patients


Twenty years ago, the Veterans Affairs (VA) health care system had some serious problems. Although problems still exist, there are also bright spots.

The VA health system is huge, caring for more than nine million veterans. It is an integrated health system similar to those in countries with fully socialized medicine.

Standards of care are uniform throughout the VA. The system uses a single electronic medical record which allows patient information to be readily available no matter where a patient goes for care.

A review of care for male veterans hospitalized with heart attack, heart failure and pneumonia found lower death rates than non-VA hospitals for heart attack and heart failure. Veterans with all three conditions were more likely to be readmitted than civilian patients with similar problems.

Led by Harlan M. Krumholz, MD, SM, the researchers analyzed data on more than 200,000 patients at both VA and non-VA hospitals. They studied only male patients since VA patients are 90 percent male.

Dr. Krumholz is a cardiologist and professor at the Yale School of Medicine.

Reforms were initiated in the late 1990s because of problems including access to care, quality of care and cost. Although reforms were successful, critics note similar problems have continued to plague the VA system.

This study looked specifically at outcomes for patients hospitalized with heart attack, heart failure and pneumonia.

Dr. Krumholz and colleagues found that veterans hospitalized with heart attack and heart failure were less likely to die than comparable non-VA patients. Veterans with pneumonia were slightly more likely to die than non-VA patients. Patients with all three conditions were more likely to be readmitted for the same problem within 30 days compared to non-VA patients.

The researchers noted that the differences in outcomes for all patients analyzed were small compared to non-VA patients.

In a related editorial, Ashish K. Jha, MD, MPH, of the Department of Health Policy and Management, at the Harvard T. H. Chan School of Public Health, noted that the results indicate VA hospitals provide comparable care to non-VA hospitals.

Dr. Jha commented in the editorial,“These findings are important because they suggest that despite all of the challenges that VA hospitals have faced, they are still able to deliver high-quality care for some of the sickest, most complicated patients.”

Dr. Jha also noted, “The finding of higher readmission rates in the VA is not surprising. It is well known that veterans who use the VA system are sicker, poorer, and often have fewer social supports than age-matched nonveterans.”

Both the study and the editorial were published in the February issue of the Journal of the American Medical Association.

The VA system, the National Institute on Aging, the American Federation for Aging Research and the National Heart, Lung, and Blood Institute provided financial support for the study or its authors.

Drs. Krumholz, Ross, Normand, Bernheim and Suter reported they are paid to develop performance measures by the Centers for Medicare & Medicaid Services.