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

作者：Eric Apaydin, Neil M. Paige, Meron M. Begashaw, Jody Larkin, Isomi M Miake-Lye, Paul G Shekelle · 发表于：Journal of General Internal Medicine · 年份：2023 · DOI：10.1007/s11606-023-08207-2 · 被引用次数：70 · 研究领域：Primary Care and Health Outcomes、Acute Myocardial Infarction Research、Chronic Disease Management Strategies

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...