Kerr Eve A, Gerzoff Robert B, Krein Sarah L, Selby Joseph V, Piette John D, Curb J David, Herman William H, Marrero David G, Narayan K M Venkat, Safford Monika M, Thompson Theodore, Mangione Carol M
Veterans Affairs Ann Arbor Healthcare System, Center for Practice Management and Outcomes Research, and University of Michigan, Ann Arbor, Michigan 48113-0170, USA.
Ann Intern Med. 2004 Aug 17;141(4):272-81. doi: 10.7326/0003-4819-141-4-200408170-00007.
No studies have compared care in the Department of Veterans Affairs (VA) with that delivered in commercial managed care organizations, nor have studies focused in depth on care comparisons for chronic, outpatient conditions.
To compare the quality of diabetes care between patients in the VA system and those enrolled in commercial managed care organizations by using equivalent sampling and measurement methods.
Cross-sectional patient survey with retrospective review of medical records.
5 VA medical centers and 8 commercial managed care organizations in 5 matched geographic regions.
8205 diabetic patients: 1285 in the VA system and 6920 in commercial managed care.
We compared scores on identically specified quality measures for 7 diabetes care processes and 3 diabetes intermediate outcomes and on 4 dimensions of satisfaction. Scores were expressed as the percentage of patients receiving indicated care and were adjusted for patients' demographic and health characteristics.
Patients in the VA system had better scores than patients in commercial managed care on all process measures (for example, 93% vs. 83% for annual hemoglobin A1c; P = 0.006; 91% vs. 75% for annual eye examination; P < 0.001). Blood pressure control was poor in both groups (52% to 53% of persons had blood pressure < 140/90 mm Hg), but patients in the VA system had better control of low-density lipoprotein cholesterol and hemoglobin A1c (for example, 86% vs. 72% for low-density lipoprotein cholesterol level < 3.37 mmol/L [<130 mg/dL]; P = 0.002). Satisfaction was similar in the 2 groups.
Our results may not be generalizable to all regions or health plans, and some of the differences in performance could reflect differences in documentation.
Diabetes processes of care and 2 of 3 intermediate outcomes were better for patients in the VA system than for patients in commercial managed care. However, both VA and commercial managed care had room for improvement, especially for blood pressure control.
尚无研究将退伍军人事务部（VA）的医疗服务与商业管理式医疗组织提供的服务进行比较，也没有研究深入关注慢性门诊疾病的医疗服务比较。
通过使用等效抽样和测量方法，比较VA系统患者与商业管理式医疗组织参保患者的糖尿病护理质量。
采用回顾性病历审查的横断面患者调查。
5个匹配地理区域的5家VA医疗中心和8家商业管理式医疗组织。
8205名糖尿病患者，其中1285名在VA系统，6920名在商业管理式医疗组织。
我们比较了7个糖尿病护理流程、3个糖尿病中间结局以及4个满意度维度的相同指定质量指标得分。得分以接受指定护理的患者百分比表示，并根据患者的人口统计学和健康特征进行调整。
在所有流程指标上，VA系统的患者得分高于商业管理式医疗组织的患者（例如，年度糖化血红蛋白检测为93%对83%；P = 0.006；年度眼部检查为91%对75%；P < 0.001）。两组的血压控制情况均较差（52%至53%的人血压<140/90 mmHg），但VA系统的患者对低密度脂蛋白胆固醇和糖化血红蛋白的控制更好（例如，低密度脂蛋白胆固醇水平<3.37 mmol/L[<130 mg/dL]时为86%对72%；P = 0.002）。两组的满意度相似。
我们的结果可能不适用于所有地区或健康计划，某些表现差异可能反映了记录方面的差异。
VA系统患者的糖尿病护理流程以及3个中间结局中的2个优于商业管理式医疗组织的患者。然而，VA和商业管理式医疗组织都有改进空间，尤其是在血压控制方面。
