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The VHA and Chronic Disease Care

By April 21, 2011Commentary

It is well-recognized now that patients with chronic disease account for the bulk of health spending and a variety of strategies have been adopted to improve the care of those patients and hopefully reduce the cost of that care.  An article in Population Health Management reviews the efforts of the Veterans Health Administration in that regard.   (PHM Article) The VHA has moved over the last two decades to a primary-care, team-based model, supported by a relatively sophisticated electronic medical record and a focus on quality improvement.  The study, however, finds significant shortcomings in the chronic disease care delivered by the system.

Patients with one or more chronic diseases account for about 96% of the VHA’s costs.  The research examined the extent to which treatment for five common chronic diseases, COPD, CAD, diabetes, heart failure and high cholesterol, followed national guidelines and demonstrated appropriate drug use and adherence.   Over 100,000 patients treated at one large regional VHA system were reviewed for the 2002-2006 time period.  The quality of care varied across diseases, generally being stronger for heart disease and diabetes and weaker for COPD and asthma.

For example, about 88% of diabetics had at least one A1C test, but only 58% had the recommended two or more and only 47% actually had an A1C result that was less than the desirable 7.  And 89% had an LDL-c test but only 35% had a test result below the good level of 100.  The percent of patients who stayed persistent with therapy  ranged from 21% to 63% and those compliant with the therapy recommendations ranged from 49% to 85%.  The interesting aspect of this is that while a provider organization can work to ensure that care guidelines are followed, actually improving health, the most important end goal, likely requires some often hard to achieve patient behavior changes.

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