VA made great gains in quality, but racial disparities persist

Trivedi, who receives a portion of its funding from VA, said that each peer review was based on widely accepted indicators of quality in the health sector. The measures indicate whether care providers followed recommended processes given the patient’s condition and whether patients were favorable. For example, for patients with quality care requires both analysis and monitoring. In his studies, Trivedi and his co-authors have analyzed millions of documented cases of health care.“From these indicators VA exceeded the private Medicare Advantage plans by a wide margin and growing,” said Trivedi. “The quality will be a function of incentives and capabilities, and incentives can be better aligned with the VA to provide high quality care.”

While the gap has not changed the quality of care did. Among patients with diabetes, only 52 percent of veterans blacks and only 61 percent of white veterans had controlled cholesterol in 2005. Between 2005 and 2009, blacks and whites saw Jump 10 percent and 11 points better, respectively.

Two new studies of metrics standards of quality in Veterans Affairs medical centers show that the system has made significant improvements in quality, in some cases, provide significantly better care than is available in private insurance plans. But for all its improvements, the VA has not been able to bridge a gap between the health outcomes of black and white patients.

For the analysis published in Health Affairs, Trivedi studied 10 quality indicators in the records of more than 1.1 million veterans. He found that in the last ten years, the VA doctors became significantly more likely to deliver better care to members of each racial group, both for the process (ordering appropriate tests) and results (best results). But why care for black veterans did not increase in quality faster than it does for white veterans, the disparity that existed before has remained stubbornly in place.

He said that the study can not explain why the gap has remained even though the VA has improved the overall quality, but the current data in the VA with the ability to recognize the disparity and focus on it.

Trivedi and co-authors of Regina Grebler, Steven Wright, and Donna Washington said that the difference is not found in some VA medical centers, but still well within the system.

The line of high quality VA, in 2007 ranged from 4.3 percentage points in the case of testing for LDL cholesterol in patients at 30.8 percentage points, with the screening offer.

After the first year, the quality of the VA has improved faster than the private plans, in most indicators. In the last year in the study, Trivedi said, the VA has passed the Medicare Advantage providers in all 12 measures studied.

In all 12 measures, the VA also had differences of lower quality than private plans between patients living in areas with the highest incomes and education levels e. For example, for diabetic patients, the difference in quality of glycemic control among patients living in wealthier areas and was 0.6 percentage points in the VA system, compared to 8.1 percentage points in the Medicare Advantage plans.

Other research, he says, has shown that racial disparities in such measures is 1.3 to 2 times higher in the Medicare system at the VA.

In the first year of the study, Trivedi said, the VA system scored higher than 11 to 10 quality measures, missing the only brand to offer eye exams for diabetic patients, 2.6 percentage points.

Overall, private Medicare plans VA benefits for patients aged 65 and over, with the analysis Trivedi published in medical care last month. With the co-author Grebler, Trivedi looked at comparable quality indicators in files 293 000 VA to 142 VA medical centers and more than 5.7 million from 305 Medicare Advantage plans between 2000 and 2007.

“The differences we saw were the outcome measures, or get the right result, in contrast with the supplier the right thing,” said Trivedi, who teaches at the Department of Community Health and Brown sees patients as a Hospitalist at the VA Medical Center in Providence.

In addition to VA, the Robert Wood Johnson Foundation funded the study published in the medical and health issues.

In a study published March 18 by the Medical Journal, found that VA Trivedi care for the elderly is always better than what is available through the private benefit plans, but another analysis published in the April issue of Health shows that if the treatment has improved for patients in both black and white, racial disparities in health persist.