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Dartmouth study finds VA hospitals outperform others in same regions

John L. McClellan Memorial Veterans Hospital (Veterans Health/Flickr)

A new study by Dartmouth College that compares Department of Veterans Affairs hospitals with other hospitals in the same regions found VA facilities often outperform others when it comes to mortality rates and patient safety.

Researchers compared performance data at VA hospitals against non-VA facilities in 121 regions. In 14 out of 15 measures, the VA performed “significantly better” than other hospitals, according to results from the study.

“We found a surprisingly high, to me, number of cases where the VA was the best hospital in the region,” said Dr. William Weeks, who led the study. “Pretty rarely was it the worst hospital.”

Weeks initiated the research after reading multiple studies from recent years that had found VA hospitals performed better than other medical systems. He was skeptical of the research, he said, because it compared data on a national level, not by region.

He wanted to take the perspective of veterans, who might get a choice between their local VA hospitals and other hospitals close by.

Weeks is a professor at the Dartmouth Institute for Health Policy and Clinical Practice and a former VA employee. He conducted the study with Alan West, who works at the White River Junction Medical Center in Vermont.

Though he used to work for the VA, Weeks said he was critical of the agency in the past. Going into the study, he thought he might find a few well-performing VA hospitals had skewed the data in previous research.

“The theory was that a few larger hospitals could be really good performers and the rest not so good,” Weeks said. “And the weight of that might make national averages look better than what might be experienced by a typical veteran. That was the premise, but we found something that was a little bit surprising.”

The researchers compared risk of death from heart failure and pneumonia at hospitals, as well as risk of blood clots, infections and wounds after surgery, among other measures.

“The primary drivers of making a decision are, ‘I don’t want to get hurt,’ and ‘I want to live through it,’” Weeks said. “That’s why we focused on these.”

With the new study, researchers are sending a message to Congress to rethink efforts to expand veterans’ health care into the private sector.

Earlier this year, President Donald Trump signed the VA Mission Act – major reform legislation that overhauls how the VA outsources health care to the private sector.

Under the bill, the VA and Congress are supposed to work together in coming months to create new rules dictating which veterans can use private-sector care and in what situations. The aim is to provide veterans more flexibility to see doctors outside of the VA system.

“One has to wonder whether outsourcing care is the right choice if we care about veterans’ outcomes,” Weeks said. “The VA is, for the most part, doing at least as well as the private sector in a local setting, and pretty often are the best performers in that setting.”


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