Table 1.
Quality and Safety Outcomes in Veterans Affairs vs Non-Veterans Affairs Care
| Author, year |
Operation, national setting |
Comparison | N | Quality/safety | ||
|---|---|---|---|---|---|---|
| George and colleagues, 202111 | Noncardiac surgery | 30-d mortality, N (%) | 30-d complication, N (%) | Failure to rescue, N (%) | ||
| VA pt | 73,6477 | 8,008 (1.1) | 125,816 (17.1) | 5,918 (4.7) | ||
| Gen pop (Ref) | 3,174,274 | 2,602 (0.8) | 299,984 (9.5) | 19,936 (6.7) | ||
| RR 0.59 (0.47–0.75)* | RR 0.55 (0.44–0.68)* | |||||
| Harris and colleagues, 202112 | TKA | Any complication, N (%) | Joint/wound infection, N (%) | PE, N (%) | ||
| VA pt | 24,407 | 712 (2.9) | 236 (1.0) | 193 (0.8) | ||
| Non-VA pt (Ref) | 18,964 | 611 (3.2) | 128 (0.7) | 109 (0.6) | ||
| OR 0.45 (0.38–0.54)* | OR 0.69* | OR 0.73 (p < 0.01)* | ||||
| Rosen and colleagues, 202113 | TKA | All-cause readmission rate, % | TKA-related readmission rate, % | |||
| VA pt | 25,384 | 4.3 | 1.3 | |||
| Non-VA pt (Ref) | 19,990 | 4.6 | 1.2 | |||
| RR 0.35 (0.30–0.40)* | RR 0.30 (0.23–0.38)* | |||||
| Frisch and colleagues, 202014 | TKA | 30-d complication, N (%) | DVT, N (%) | 30-d readmit, N (%) | ||
| VA pt | 10,460 | 908 (9) | 152 (1.5) | 1,773 (17) | ||
| Gen pop (Ref) | 58,820 | 1,608 (3) | 414 (0.7)† | 1,955 (3) | ||
| OR 2.58 (2.31–2.89)† | OR 4.94 (4.51–5.41)† | |||||
| Hutt and colleagues, 201515 | Hip fracture repair | 30-d survival, % | 1-y survival, % | Admit to surgery time, d, mean (SD) | ||
| VA pt (Ref) |
947 | 89.65 | 63.04 | 5.64 (43.25) | ||
| OR 1.701 (1.184–2.445)† | OR 1.504 (1.208–1.872)† | |||||
| Medicare | 947 | 92.93 | 70.43 | 1.78 (2.35)† | ||
| Heiden and colleagues, 202116 | Lung resection | 30-d mortality, N (%) | Median overall survival, mo | 30-d readmit, N (%) | ||
| VA pt | 6,792 | 128 (1.9)‡ | 71.4‡ | 523 (7.70) | ||
| Non-VA pt | 6,792 | 188 (2.8) | 65.2 | 470 (7.02)NS | ||
| Williams and colleagues, 202017 | Lung cancer treatment | Surgical treatment only, N (%) | Chemotherapy only, N (%) | 5-y overall survival, % | ||
| VA Black race vs White race (Ref) |
7,895 | 3,648 (46.2) | 181 (2.3) | HR 1.08 (1.00–1.16) | ||
| OR 0.73 (0.62–0.86) | ||||||
| Gen pop Black race vs White race (Ref) |
8,744 | 4,454 (50.9) | 171 (2.0) | HR 1.17 (1.06–1.30) | ||
| OR 0.57 (0.47–0.70) | ||||||
| Augustine and colleagues, 201818 | Kidney transplant | Mortality | Delisting | |||
| VA pt | 2,905 | |||||
| Private (Ref) | 3,751 | HR 1.00 (0.83–1.20)NS | HR 1.23 (1.003–1.50)NS | |||
| Medicare (Ref) | 3,109 | HR 0.81 (0.68–0.96)* | HR 0.82 (0.68–0.99)* | |||
| Kesseli and colleagues, 202019 | Kidney transplant | 30-d mortality, O/E | 1-y graft survival, O/E | |||
| VA pt | 1,508 | 3/11.3 (0.26) | 78/97.8 (0.79) | |||
| O/E adj 0.27 (0.05–0.65)* | O/E adj 0.79 (0.63–0.98)NS | |||||
| Gen pop | 227,680 | 1,348/1,340 (1.01) | 14,185/14,149 (1.00) | |||
| O/E 1.00 (0.95–1.06) | O/E adj 1.00 (0.98–1.02) | |||||
| Barnett and colleagues, 201820 | CABG | 30-d mortality, N (%) | 30-d readmit, N (%) | |||
| VA pt | 4,866 | 77 (1.50) | 346 (7.12) | |||
| Non-VA pt (Ref) | 952 | 12 (1.26) | 79 (8.25) | |||
| RR 0.89 (0.45–1.77)NS | RR 1.16 (0.89–1.50)NS | |||||
| Blay and colleagues, 201721 |
Surgical PSI | Failure to rescue, N/1,000 discharges (CI) | Wound dehiscence, N/1,000 discharges (CI) | VTE/PE, N/1,000 discharges (CI) | ||
| VA hospital | 129 | 105.82 (96.7–114.92)* | 2.17 (1.64–2.71)NS | 3.94 (3.42–4.45)* | ||
| Non-VA pt | 4,010 | 136.34 (135.42–137.26) | 2.32 (2.30–2.33) | 5.08 (5.00–5.15) | ||
| Eid and colleagues, 202022 | Surgical PSI | Postop mortality, N/1,000 pts | Wound dehiscence, N/1,000 pts | VTE/PE, N/1,000 pts | ||
| VA hospital | 34 | 95* | 0.29* | 3.56NS | ||
| Non-VA pt | 319 | 167 | 0.83 | 4.05 | ||
| Rosen and colleagues, 202123 | Cataract | 30-d complication complex surgery, N (%) | 30-d complication routine surgery, N (%) | 90-d complication, N | ||
| VA pt (Ref) | 44,546 | 164 (1.61) | 313 (0.65) | 704 | ||
| RR 0.94 (0.70–1.27)NS | RR 0.91 (0.74–1.16)NS | OR 0.918 (0.765–1.097)NS | ||||
| Non-VA pt | 17,203 | 58 (1.52) | 131 (0.59) | 276 | ||
Data shown as 95% CI and mean (SD) unless otherwise specified. NS, p > 0.05.
*
Significantly favors VA.
†
Significantly favors non-VA.
‡
Significantly favors VA in unadjusted analysis.
CABG, coronary artery bypass graft; CI, confidence interval; HR, hazard ratio; IQR, interquartile range; LOS, length of stay; N, number; O/E, observed/expected ratio; OLS coeff, ordinary least squares coefficient; OR, odds ratio; PSI, patient safety indicators; RR, relative risk; TKA, total knee arthroplasty; VA, Veterans Health Administration; VTE/PE, venous thromboembolism/pulmonary embolism.