Death rates for heart attack patients treated in hospitals operated by the Department of Veterans Affairs are the same as those of Medicare patients, and both groups receive roughly the same quality of care, according to a study published in the New England Journal of Medicine. The study, which appears in the Dec. 28 edition of the journal, hypothesized that VA patients 65 years old or older who were treated for heart attacks would receive poorer care than Medicare patients. However, investigators discovered that heart attack patients admitted to VA medical centers had survived just as long-one year and 30 days-as those treated through the Medicare program, even though the VA patients generally were more chronically ill and had sustained more serious heart attacks. "With extensive risk adjustment, we have found no differences in mortality between VHA [Veterans Health Administration] patients and fee-for-service Medicare patients, suggesting that VHA patients receive care of similar quality for acute myocardial infarction [heart attack]," the study's authors concluded. The study found that more VHA patients received greater doses of beta-blockers, aspirin and other medications designed to prevent heart attacks than Medicare patients-a conclusion the study's authors say contributed to lower mortality rates. For years, VA's health care system has been criticized for poor quality of care and inefficiency. Under Kenneth Kizer, former Veterans Affairs undersecretary for health, the Veterans Health Administration instituted a number of reforms in the mid-1990s. Among them were more sophisticated data-collecting on the risks associated with surgical procedures; stricter credentials for staff; and an auditing system for medical records that tracks prevention and disease management and is aimed at helping to increase patient care and safety. According to Linda Bennett, a lobbyist for the American Federation of Government Employees, the New England Journal of Medicine study demonstrates the high quality of care in VHA hospitals. "The study should give pause to those in Congress who think that contracting out veterans' health care is better for veterans. The study shows that VA employees do provide better care for sicker veterans than private sector hospitals," said Bennett. In fiscal 1999, VA spent $189 million on contract hospitalization, and expects to spend $225 million in fiscal 2001-a 20 percent increase. VA operates 173 medical centers, 134 nursing home and more than 600 community clinics. In 1999, VHA hospitals treated 3.4 million patients.
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