Study: VA Bests Managed Care on Diabetes

August 16, 2004 07:20 PM EDT


PHILADELPHIA - Diabetic patients treated by the country's long-maligned VA
health system got better care than diabetics under managed health care plans,
according to a new study.

Researchers found that the diabetics served by the Department of Veterans
Affairs had better control over their cholesterol and got more frequent blood
tests, eye and foot exams than diabetics served by the commercial health groups.

The findings appear in Tuesday's issue of Annals of Internal Medicine. The
study was funded by the VA, the U.S. Centers for Disease Control and Prevention,
and the National Institute of Diabetes and Digestive Kidney Diseases.

"The VA has made great strides in the past 10 years," said Dr. Eve A.
Kerr, the study's lead author, who is a research scientist at the VA Ann Arbor
Healthcare System and assistant professor of internal medicine at the University
of Michigan Medical School. "What this tells us is that a nationally funded
health care system can provide excellent quality of care."

Researchers compared the care received by 6,900 diabetics in eight managed
care health plans with about 1,300 diabetics in five VA medical centers in
Indiana, California, Texas, Michigan, Pennsylvania and New Jersey. They matched
the two patient groups geographically and used statistical sampling to make the
demographics comparable.

Compared to their managed care counterparts, diabetes patients treated by
VA doctors more often received the recommended annual blood tests (93 percent
vs. 83 percent), eye exams (91 percent vs. 75 percent); and foot exams (98
percent vs. 84 percent).

The VA group also received more cholesterol testing (79 percent vs. 63
percent) and had better control of their cholesterol levels as a result,
according to the study.

Both groups of patients reported similarly high levels of satisfaction for
the care they received.

VA patients often are older, poorer, sicker and more likely to be male
than patients in managed care, but Kerr said that the statistics were adjusted
to accommodate the variations.

"The results are adjusted so we're comparing apples to apples," she said.
She also acknowledged that because the research looked at eight managed care
organizations in five regions of the country, the results might not apply
everywhere.

In 1995, the VA began to transform itself from a hospital operator to a
health care provider relying on community-based medical and residential
facilities and outpatient services.

Despite the more positive results for the VA, a spokeswoman for an
industry group that represents commercial managed care, also called the study
encouraging.

"It shows that if you focus on scientific evidence, reward good
performance and follow guidelines, quality improves. These are the very same
approaches that managed care has advocated and advanced," said Susan Pisano of
America's Health Insurance Plans.

The challenge now is finding ways to apply some of the VA's successes with
chronic disease treatment to smaller health care groups and private practices
where most Americans are treated, according to an editorial accompanying the
study.

More study is needed to see whether such marked differences are similar
with patients with ailments other than diabetes, said Dr. Sheldon Greenfield and
Sherrie Kaplan of the University of California, Irvine, who were not connected
to the study.

"It's an almost heroic effort, what the VA has done," Greenfield said.
"Many of the elements that it has implemented can be brought to other settings."

The VA in 2003 treated about 4.8 million patients at its health care
facilities, which includes outpatient clinics, nursing homes and residential
rehabilitation programs and more than 150 hospitals.

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On the Net:

http://www.annals.org


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