Where VA Hospitals Lead and Lag in New York State

Print

.@NYHFoundation Data Snapshot: Performance of VA hospitals in New York State.

New York's VA hospital performance: Patient satisfaction, patient safety, health outcomes, and the timeliness and effectiveness of care.

Introduction

This data snapshot displays levels of performance on various quality measures for each of the 10 Veterans Affairs (VA) hospitals in New York State. The measures span four domains of care: patient satisfaction, patient safety, health outcomes, and the timeliness and effectiveness of care.

For each quality measure, the performance of each VA hospital is displayed relative to community-based (i.e., non-VA) hospitals within the same region of the State as well as to statewide averages. (See a summary of all VA hospital measures by region.) The measures pertain to hospital performance from 2014 to 2017, depending on the measure. Details on the data, measures, and the calculations used for regional and statewide community-based hospitals are discussed in the Methodology section.

Key findings include:

VA hospitals and community-based hospitals perform similarly on most measures. VA hospitals do not consistently out- or under-perform relative to community-based hospitals across the measures included here.
There are a few exceptions in which VAs perform, on the whole, better or worse than community-based hospitals.
- VA hospitals tend to perform better than their regional community-based hospitals for health outcomes related to chronic obstructive pulmonary disease (COPD) and in fewer deaths within 30 days of discharge among heart failure patients.
- Conversely, VA hospitals tended to perform worse than community-based hospitals in 30-day readmissions for heart attack, heart failure, and pneumonia patients.
There were no consistent patterns related to how VA hospitals performed relative to each other. Each of the VA hospitals seem to be better in some quality measures and worse on others.

These mixed results underscore the value of veterans having options of both VA and community-based care. Having choice is even more important considering that there are only 10 VA hospitals in the State, and 3 of New York State’s 11 regions have no VA hospital (see a list of hospitals by region and a map of VA hospitals). Many of the nearly 800,000¹ veterans in New York State do not live near these facilities.

With information on the performance of New York State’s VA hospitals and community-based hospitals in their region or across the State, veterans can seek the best possible care available to them.

1 US Department of Veterans Affairs. State Summary New York FY2017 [dataset]. VA Open Data Portal, https://www.data.va.gov/. Published 10/30/2018. Accessed 3/18/2019.

Patient Satisfaction

Measures of patient satisfaction are based on responses to the Hospital Consumer Assessment of Healthcare Providers and Systems (HCAHPS) survey. Patients are sampled from each hospital for the survey. The Centers for Medicare & Medicaid (CMS) requires all hospitals to conduct the HCAHPS survey. Patient satisfaction is evaluated across eight domains, including clinician communication, staff responsiveness, hospital environment, and discharge information.

These measures represent the patients’ experience of care during an inpatient stay. For all measures, a higher value indicates better performance.

Patient Safety

Patient Safety Indicators (PSI) are a standardized series of measures established by the Agency for Healthcare Research and Quality (AHRQ) to capture the rate of potentially preventable adverse events during and after surgeries and other procedures. We display the results for four PSI measures: collapsed lung due to medical treatment, in-hospital hip fracture due to fall, accidental cuts or tears due to medical treatment, and pressure ulcers.

All measures are expressed as a rate per 1,000 patients. Lower rates indicate better performance.

Note: Across these four measures, many of the VA hospitals reported zero events (a rate of 0.00). For hospitals that report more than zero events, the rate is often markedly higher than the regional or state averages. This large variation can result from relatively small patient populations at individual hospitals and not necessarily poor performance. PSI measures should be considered with caution.

Health Outcomes

Thirty-day death and readmission rates are shown for four index conditions: chronic obstructive pulmonary disease, heart attack, heart failure, and pneumonia. The death rates shows the number of patients with the index condition who die within 30 days of hospital discharge. Likewise, the readmission rates show the number of patients who are readmitted to the hospital within 30 days of discharge.

All measures are expressed as a rate per 100 patients with the index condition. Lower rates represent better performance.

Thirty-day death rates due to chronic obstructive pulmonary disease (COPD) are substantially lower across all New York State VA hospitals compared with community-based hospitals. Similarly, COPD-related 30-day readmission rates tend to be lower among VA hospitals than community-based hospitals. In contrast, heart attack, heart failure, and pneumonia 30-day readmission rates tend to be higher at VA hospitals compared with community-based hospitals.

Timely and Effective Care

Emergency Department Wait Times

Three measures are displayed related to timely and effective care in hospital emergency departments (EDs). The first two measures show (1) the median time between patient arrival in the ED and the decision to admit and (2) the median time between decision to admit and departure from the ED for admitted patients. Both measures show time in minutes; lower values are better.

Several VA hospitals have longer ED wait times both between arrival and admission and between decision to admit and hospital admission than community-based hospitals.

Timely and Effective Care

Flu Vaccine in the Emergency Department

The third measure represents the percent of ED patients assessed for and given the influenza vaccine. Higher values for this measure are better, and reflect greater thoroughness in implementing preventive care measures.

Influenza vaccination rates for ED patients fall short of New York State and regional rates for almost all VA hospitals.

Methodology

The data reflected in these charts are the most recent Hospital Compare measures reported by the Centers for Medicare & Medicaid Services². We focus on four categories of performance—patient satisfaction, patient safety, health outcomes, and timely and effective care. Though CMS Hospital Compare data includes several additional measures in the categories noted above, we included measures with data for 70% or more of New York State’s VA hospitals. The exception to the 70% threshold is for the Timely and Effective Care category, which had more missing data that other categories. For this category, we set a threshold of 60% data completeness when selecting measures.

In order to facilitate comparisons between VA and community-based hospitals, state averages for community-based hospitals are presented as reported by CMS Hospital Compare. For measures that did not have a statewide average reported in CMS data, we calculated a weighted average across New York State hospitals, weighting each hospital’s value by the denominator of the measure. Regional community-based hospitals are also represented as the median value of community-based hospitals located in the same region as the VA hospital(s).