title: Comparing VA and Non-VA Quality of Care: A Systematic Review.
abstract: The Veterans Affairs (VA) health care system aims to provide high-quality medical care to veterans in the USA, but the quality of VA care has recently drawn the concern of Congress. The objective of this study was to systematically review published evidence examining the quality of care provided at VA health care facilities compared to quality of care in other facilities and systems.
  
  
  
  Building on the search strategy and results of a prior systematic review, we searched MEDLINE (from January 1, 2005, to January 1, 2015) to identify relevant articles on the quality of care at VA facilities compared to non-VA facilities. Articles from the prior systematic review published from 2005 and onward were also included and re-abstracted. Studies were classified, analyzed, and summarized by the Institute of Medicine's quality dimensions.
  
  
  
  Sixty-nine articles were identified (including 31 articles from the prior systematic review and 38 new articles) that address one or more Institute of Medicine quality dimensions: safety (34 articles), effectiveness (24 articles), efficiency (9 articles), patient-centeredness (5 articles), equity (4 articles), and timeliness (1 article). Studies of safety and effectiveness indicated generally better or equal performance, with some exceptions. Too few articles related to timeliness, equity, efficiency, and patient-centeredness were found from which to reliably draw conclusions about VA care related to these dimensions.
  
  
  
  The VA often (but not always) performs better than or similarly to other systems of care with regard to the safety and effectiveness of care. Additional studies of quality of care in the VA are needed on all aspects of quality, but particularly with regard to timeliness, equity, efficiency, and patient-centeredness.
authors.affiliation: Pardee RAND Graduate School, Santa Monica, CA, USA. cohanlon@rand.org.|RAND Corp., Santa Monica, CA, USA. cohanlon@rand.org.
authors.forename: Claire
authors.initials: C
authors.lastname: O'Hanlon
authors.affiliation: Pardee RAND Graduate School, Santa Monica, CA, USA.|RAND Corp., Santa Monica, CA, USA.
authors.forename: Christina
authors.initials: C
authors.lastname: Huang
authors.affiliation: RAND Corp., Arlington, VA, USA.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: Sloss
authors.affiliation: RAND Corp., Arlington, VA, USA.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Anhang Price
authors.affiliation: RAND Corp., Boston, MA, USA.
authors.forename: Peter
authors.initials: P
authors.lastname: Hussey
authors.affiliation: RAND Corp., Pittsburgh, PA, USA.
authors.forename: Carrie
authors.initials: C
authors.lastname: Farmer
authors.affiliation: RAND Corp., Boston, MA, USA.
authors.forename: Courtney
authors.initials: C
authors.lastname: Gidengil
mesh_terms: D003695:Delivery of Health Care / Q000592:standards*; D017052:Hospital Mortality; D006787:Hospitals, Veterans / Q000458:organization & administration* / Q000592:standards; D006801:Humans; D017063:Outcome Assessment, Health Care; D061214:Patient Safety / Q000592:standards; D018802:Patient-Centered Care / Q000592:standards; D019984:Quality Indicators, Health Care / Q000592:standards*; D011787:Quality of Health Care / Q000592:standards*; D014481:United States
keywords: Veterans Affairs; Veterans Health Administration; quality; systematic review; veterans