James J. Peters VA Medical Center, Bronx, New York.
Icahn School of Medicine at Mount Sinai, New York, New York.
Popul Health Manag. 2020 Feb;23(1):92-100. doi: 10.1089/pop.2019.0039. Epub 2019 Jul 9.
The VA Mission Act of 2018 allows for choice of health care for 9 million veterans in their community, but deciding where the best care is requires transparency. Recent reports questioning the transparency of reporting health care outcomes in the Department of Veterans Affairs (VA), the largest US health care organization, pointed to flaws in how VA tracks and improves performance, and posed questions about the validity and transparency of using popular hospital ratings systems to define good care. To explore this further, the authors examined 3 widely referenced public health care ranking models - U.S. News America's Best Hospitals, Truven Health Analytics, and Hospital Compare - and the VA model. Upon examination, the authors find that metrics used across the 4 models are neither comparable nor transparent. Between 6%-46% reporting deficiencies were found in reporting of hospital metrics in non-VA hospitals, which reduces transparency for the public. In contrast, VA reporting is 100%. Comparing VA health care and Hospital Compare quality outcomes showed similar or better outcomes for VA for the same metrics of quality and for comparable health care costs. VA inpatient satisfaction falls significantly short of the private sector, but no individual VA outcome measure was found to contribute significantly to inpatient satisfaction. However, overall inpatient satisfaction increased over time with higher global hospital ranking in both VA and non-VA health care. Encouraging use of uniform rating models and reporting of metrics from all hospitals would improve transparency of current health care reporting to the consumer.
2018 年的《退伍军人事务部使命法案》允许 900 万社区退伍军人选择医疗保健，但要确定最佳医疗保健在哪里，需要透明度。最近的报告质疑美国退伍军人事务部（VA）报告医疗保健结果的透明度，VA 是美国最大的医疗保健组织，该报告指出 VA 跟踪和提高绩效的方式存在缺陷，并对使用流行的医院评级系统来定义良好护理的有效性和透明度提出了质疑。为了进一步探讨这个问题，作者研究了 3 种广泛引用的公共医疗保健排名模型——《美国新闻与世界报道》的美国最佳医院、Truven Health Analytics 和医院比较——以及 VA 模型。经审查，作者发现 4 个模型中使用的指标既不可比也不透明。在非 VA 医院报告的医院指标中，发现有 6%-46%的报告缺陷，这降低了公众的透明度。相比之下，VA 的报告是 100%。将 VA 医疗保健和医院比较的质量结果进行比较，对于相同的质量指标和可比的医疗保健费用，VA 的结果相似或更好。VA 住院病人满意度明显低于私营部门，但没有发现 VA 的任何个别结果衡量指标对住院病人满意度有显著影响。然而，随着 VA 和非 VA 医疗保健全球医院排名的提高，整体住院病人满意度随着时间的推移有所提高。鼓励使用统一的评级模型和报告所有医院的指标，将提高当前医疗保健报告对消费者的透明度。
