Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

Eric A Apaydin; Neil M Paige; Meron M Begashaw; Jody Larkin; Isomi M Miake-Lye; Paul G Shekelle

doi:10.1007/s11606-023-08207-2

Veterans Health Administration (VA) vs. Non-VA Healthcare Quality: A Systematic Review

J Gen Intern Med. 2023 Jul;38(9):2179-2188. doi: 10.1007/s11606-023-08207-2. Epub 2023 Apr 19.

Authors

Eric A Apaydin^{1

2}, Neil M Paige^{3

4}, Meron M Begashaw³, Jody Larkin⁵, Isomi M Miake-Lye^{3

6}, Paul G Shekelle^{3

7

4}

Affiliations

¹ Evidence Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA. [email protected].
² RAND Corporation, Santa Monica, CA, USA. [email protected].
³ Evidence Synthesis Program, VA Greater Los Angeles Healthcare System, Los Angeles, CA, USA.
⁴ Department of Medicine, David Geffen School of Medicine, University of California, Los Angeles, CA, USA.
⁵ RAND Corporation, Pittsburgh, PA, USA.
⁶ Department of Health Policy and Management, Fielding School of Public Health, University of California, Los Angeles, CA, USA.
⁷ RAND Corporation, Santa Monica, CA, USA.

Abstract

Background: The Veterans Health Administration (VA) serves Veterans in the nation's largest integrated healthcare system. VA seeks to provide high quality of healthcare to Veterans, but due to the VA Choice and MISSION Acts, VA increasingly pays for care outside of its system in the community. This systematic review compares care provided in VA and non-VA settings, and includes published studies from 2015 to 2023, updating 2 prior systematic reviews on this topic.

Methods: We searched PubMed, Web of Science, and PsychINFO from 2015 to 2023 for published literature comparing VA and non-VA care, including VA-paid community care. Records were included at the abstract or full-text level if they compared VA medical care with care provided in other healthcare systems, and included clinical quality, safety, access, patient experience, efficiency (cost), or equity outcomes. Data from included studies was abstracted by two independent reviewers, with disagreements resolved by consensus. Results were synthesized narratively and via graphical evidence maps.

Results: Thirty-seven studies were included after screening 2415 titles. Twelve studies compared VA and VA-paid community care. Most studies assessed clinical quality and safety, and studies of access were second most common. Only six studies assessed patient experience and six assessed cost or efficiency. Clinical quality and safety of VA care was better than or equal to non-VA care in most studies. Patient experience in VA care was better than or equal to experience in non-VA care in all studies, but access and cost/efficiency outcomes were mixed.

Discussion: VA care is consistently as good as or better than non-VA care in terms of clinical quality and safety. Access, cost/efficiency, and patient experience between the two systems are not well studied. Further research is needed on these outcomes and on services widely used by Veterans in VA-paid community care, like physical medicine and rehabilitation.

Keywords: VA; access; community care; cost; inpatient; outpatient; patient experience; quality; safety.

Publication types

Systematic Review
Research Support, Non-U.S. Gov't

MeSH terms

Delivery of Health Care
Humans
Quality of Health Care
United States
United States Department of Veterans Affairs
Veterans Health*
Veterans*