Study finds VA maintained quality despite shift to outpatient care

HOUSTON - Survival rates among chronically ill veterans remained constant in the mid-1990s despite a sharp reduction in hospital-based care provided by the Veterans Affairs (VA) health care system, report researchers in the Oct. 23 New England Journal of Medicine. The study is the largest assessment to-date of the impact on veterans of VA's shift nearly a decade ago from a hospital-based system to one focused on primary and outpatient care.

Researchers at VA's Houston Center for Quality of Care and Utilization Studies (HCQCUS) and Baylor College of Medicine studied the records of 342,300 chronically ill veterans to track their health care and survival between 1994 and 1998. A reorganization of VA health care began in 1995, geared toward reducing hospital usage and emphasizing more efficient and comprehensive care through VA primary care physicians and outpatient clinics.

According to the study, VA hospital stays fell by 50 percent and outpatient care increased moderately. Patient survival rates remained largely unchanged. The researchers also found no increase in the use of non-VA hospitals by those VA beneficiaries also covered by Medicare. That would have meant taxpayer savings on VA health care were eaten up by larger Medicare expenses.

"One remarkable finding was that Medicare-eligible veterans in our study did not significantly increase their use of Medicare-paid hospital days during the time when VA hospitalization rates were falling" said lead author Dr. Carol Ashton, director of HCQCUS and a professor of medicine at Baylor.

The researchers also found no hike in emergency-room visits. The patients included in the study had serious illnesses such as lung, kidney or heart disease, so scaling back regular hospital admissions might have forced the need for more emergency care.

"We thought emergency and urgent-care visits would increase or survival rates would drop if access to hospital care was reduced too much, or i

Contact: Matt Price
VA Research Communications Service

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