title: VA community-based outpatient clinics: quality of care performance measures.
abstract: BACKGROUND
  The Veterans Health Administration (VHA) recently initiated a system of Community-Based Outpatient Clinics (CBOCs) to enhance delivery of primary care to veterans.
  
  
  OBJECTIVE
  The objective of this study was to compare quality of care provided to veterans at CBOCs and at traditional hospital-based VA Medical Center (VAMC) clinics.
  
  
  METHODS
  Quality of care was assessed using medical record data abstracted at CBOCs and VAMCs. The analysis used a logistic regression model that allowed for possible within-facility correlation and controlled for patient differences between facilities.
  
  
  METHODS
  The study included 4768 patients from 20 geographically diverse CBOCs and 2433 patients from the 20 VAMCs associated with these CBOCs.
  
  
  METHODS
  Quality of care was measured using 7 Prevention Index (PI) indicators and 9 Chronic Disease Care Index (CDCI) indicators, which assess compliance with nationally recognized guidelines for primary prevention, early disease detection, and care of patients with chronic disease.
  
  
  RESULTS
  In the overall CBOC versus VAMC comparisons, performance was not significantly different on 15 of the 16 PI and CDCI indicators. In the comparisons between individual CBOCs and VAMCs pairs, 5 out of 20 CBOCs performed significantly below the affiliated VAMC on 4 or more indicators.
  
  
  CONCLUSIONS
  These results suggest that CBOCs overall are providing a similar level of quality of care as VAMCs based on the PI and CDCI, although performance at several individual CBOCs fell below their affiliated VAMC on some indicators. Therefore, it appears that CBOCs are a valid approach for providing quality primary care to veterans.
authors.affiliation: Health Services Research and Development, Northwest Center for Outcomes Research in Older Adults, VA Puget Sound Health Care System, Seattle, Washington 98108, USA. Ashley.Hedeen@med.va.gov
authors.forename: Ashley N
authors.initials: AN
authors.lastname: Hedeen
authors.forename: Patrick J
authors.initials: PJ
authors.lastname: Heagerty
authors.forename: John C
authors.initials: JC
authors.lastname: Fortney
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Borowsky
authors.forename: Debby J
authors.initials: DJ
authors.lastname: Walder
authors.forename: Michael K
authors.initials: MK
authors.lastname: Chapko
mesh_terms: D000368:Aged; D002908:Chronic Disease; D003151:Community Health Centers / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006282:Health Personnel / Q000592:standards / Q000706:statistics & numerical data; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D010043:Outcome and Process Assessment, Health Care; D010044:Outpatient Clinics, Hospital / Q000592:standards* / Q000706:statistics & numerical data; D011315:Preventive Medicine / Q000592:standards / Q000706:statistics & numerical data; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000592:standards* / Q000706:statistics & numerical data; D014481:United States; D014493:United States Department of Veterans Affairs