| Safety: 22 of 34 articles found VA generally performed as well as or better than other systems Mortality: “VA facilities generally performed comparably or favorably relative to other settings.” Morbidity: VA had mixed results compared with non-VA facilities. Complications: “Surgical complication rates were similar among VA patients and non-veterans.” Effectiveness: 17 of 24 studies “showed better performance in VA facilities.” Outpatient care: “was generally strong in VA facilities. … VA patients also received more effective care than non-veterans based on 10 of 11 quality measures in the first study year and all 12 quality measures in the second study year assessing diabetes, cardiovascular, and cancer screening care.” Non-ambulatory care: VA and non-VA care were “generally of similar quality.” Medication management: “Elderly VA patients were less likely to receive inappropriate medication than were patients in Medicare HMOs.” Availability of services: “VA centers were less likely to offer extensive reproductive services but more likely to offer mental health care” than 13 Department of Health and Human Services Centers of Excellence. “VA patients and Medicare/Medicaid-insured patients were less likely to receive kidney transplants than were patients with private insurance.” The Harvard article begins by noting that 14 of the department’s 17 top leaders were eventually replaced after the scandal. The transgressions have totally overshadowed a number of points that McDonald has tried to emphasize, with limited success. According to Harvard, VA: provided some training to 70 percent of U.S. doctors, “making VA a pillar of the nation’s health care system.” researchers have earned three Nobel Prizes in medicine. did the first successful liver transplant. developed the nicotine patch and the cardiac pacemaker. Despite steadily growing budgets, the report said, VA funding has been “outstripped by the growing veteran population, mounting costs, and increasing complexity of care.” The report’s authors are Professors Ryan W. Buell and Robert S. Huckman and independent researcher Sam Travers. After McDonald’s team took over, they “uncovered a department in disarray,” Harvard reported. “For example, roughly 500,000 veterans were waiting for appointments system-wide, but there weren’t systems in place to identify how many of those veterans needed to be seen urgently and how many required routine care.” McDonald dubbed his set of reforms “MyVa.” One of its “most significant new programs was the Diffusion of Excellence Initiative, which solicited innovative health care practices from VA employees across the enterprise and helped spread these practices to other VA facilities,” the Harvard article said. VA101 and Leaders Developing Leaders are training programs designed, Harvard said, “to help transform VA’s culture.” Progress has been made, but that generates other issues. As service improved, wait times for patients increased. The reason: Better service attracted more patients. “In some ways,” according to Harvard, “making service better was making service worse.” If VA must have a service problem, that’s the one to have. Read more: [Wage a ‘straight-out war’ on federal bureaucracy, Gingrich urges Trump] [Trump plans to fire federal workers faster] [Dubious constitutional effort to cut due process for top civil servants spreads across government] [DOJ won’t defend measure that facilitates VA firings] | 