Effect of the transformation of the Veterans Affairs Health Care System on the quality of care.
This study demonstrated the impact of a system-wide reengineering initiative on performance in the quality of preventive, acute, and chronic care. Investigators tracked quality-of-care indicators and compared trends internally and with fee-for-service Medicare recipients between 1994 and 2000. Findings illustrated significant improvements over time for all indicators within the Veterans Affairs (VA) health care system and better quality scores than Medicare on 12 of 13 indicators in 2000. The VA's success was attributed to the use of information technology systems, a model for integration of patient care services, and systematic measurement and reporting practices to drive quality improvement efforts. This study generated support for proponents of integrated health care systems and the business case for quality and safety. A leader in these arenas, the VA has also developed system-based approaches to improve quality and safety on a national level (see National Center for Patient Safety).