Survey: VA hospitals get high marks, but disparities still exist

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Although an investigation of 124 Veteran Affairs' (VA) hospitals revealed that the quality of care had significantly improved over the past decade, discrepancies of care still exist within certain segments including minorities, gender and those with mental disorders, according to the 2009 Department of VA hospital quality report.

“This report demonstrates VA's determination to be open and accountable,” said Secretary of Veterans Affairs Eric K. Shinseki. “As a healthcare organization, transparency of information is essential to providing quality care for our veterans.”

Although few disparities still exist, of the veterans surveyed most reported that care in VA hospitals was “very good” or “excellent.” According to the department, the hospitals are providing “exceptional service,” which sometimes equals or outshines data reported by commercial health plans or the Center for Medicare & Medicaid Services (CMS).

During the period of the study, over 67 million outpatient visits were made to VA facilities by 5.6 million veterans. The results found that scores for disease composites in the VA facilities were “uniformly high,” reaching up into the range of 80 to 90 percent.

Results showed that gender-specific care, particularly for women, including breast cancer and cervical cancer screenings, exceeded care in other settings such as managed care systems, Medicare and Medicaid, according to the VA.

However, findings showed that disparities existed between the care of male and female veterans. The VA acknowledged that these discrepancies were related to cardiovascular care and its risk factors. According to the survey, scoring related to care for high blood pressure and cholesterol were 10 to 20 percent lower for women compared with men. In addition, the study found that women had less favorable scores for diabetes care, and there were noteworthy differences between preventative activities for women including, screening for colon cancer, depression and immunizations.

According to the VA, 83 percent of male veterans are screened for colorectal cancer, compared to 75 percent of female veterans. Also, the study found variations between genders in regard to the administration of immunizations, where female veterans received immunizations at lower rates than males.

Veterans with mental health disorders were less likely to receive preventative health services, compared to those without. The VA said that this is “concerning,” because many veterans suffer from post-traumatic stress disorder, severe mental illness and schizophrenia. The VA noted that these veterans are at a higher risk for chronic diseases because of their amplified rates of smoking, poor nutrition and lack of physical activity.

The results also found deviations in comparing the satisfaction of care of black and white veterans. Black veterans were generally less satisfied with inpatient and outpatient care compared to that of whites. According to the VA, a minority veteran program coordinator has been placed in each medical center to help increase the satisfaction of care for minority veterans.

In the case of mortality, results indicated that the rates of those treated at VA hospitals were 3 percent lower than the average CMS rate, while only one hospital of the 124 surpassed the average CMS rate.

According to the VA, marked improvements have been made at facilities including:

  • Providing smoking cessation counseling to 89 percent of Veteran patients--a 6 percent improvement from 2008;
  • Providing 94 percent of veterans with pneumonia immunizations--a 4 percent increase from last year; and
  • Placing women’s advocates in outpatient clinics and medical centers to increase priorities for women veterans.