Many have criticized the Veterans Health Administration (VA) hospitals for providing poorer quality of care than non-VA health care facilities. Yet, elderly men being treated for heart attack at VA hospitals were as likely or more likely than similar Medicare fee-for-service (FFS) patients treated at non-VA hospitals to receive medications of known benefit, according to a recent study that was supported in part by the Agency for Healthcare Research and Quality (HS08071).
The researchers analyzed clinical data on 2,486 VA and 29,249 FFS patients discharged with a diagnosis of acute myocardial infarction (AMI, heart attack) from 81 VA hospitals and 1,530 non-VA hospitals. They examined appropriate use of medications for AMI among ideal candidates (those considered candidates for these medications based on current guidelines for AMI treatment). Ideal VA candidates were 40 percent more likely to undergo thrombolytic (clot-busting) therapy at hospital arrival, much more likely to receive angiotensin converting enzyme (ACE) inhibitors or aspirin at discharge, and equally likely to receive beta-blockers at discharge as ideal candidates treated in non-VA hospitals.
Several reasons may explain why VA patients were more likely to receive some of the treatments studied. The VA disseminates information on best practices to practitioners, collects and monitors data, and provides feedback on performance measures to clinicians. Also, many more VA hospitals are affiliated teaching hospitals (81 vs. 34 percent), which have been shown to have better care processes and patient survival rates than nonaffiliated hospitals. A previous study by these researchers showed similar mortality rates among VA and Medicare patients being treated for AMI. They suggest that the appropriate use of AMI medications at VA hospitals may not offset the disadvantage of known lower use of invasive procedures in VA patients.
See "Comparison of use of medications after acute myocardial infarction in the Veterans Health Administration and Medicare," by Laura A. Petersen, M.D., M.P.H., Sharon-Lise T. Normand, Ph.D., Lucian L. Leape, M.D., and Barbara J. McNeil, M.D., Ph.D., in the December 11, 2001 Circulation 104, pp. 2898-2904.