VA Community-Based Outpatient Clinics - Quality of care performance measures

BACKGROUND. The Veterans Health Administration (VHA) recently initiated a system of Community-Based Outpatient Clinics (CBOCs) to enhance delivery of primary care to veterans. OBJECTIVE. The objective of this study was to compare quality of care provided to veterans at CBOCs and at traditional hospital-based VA Medical Center (VAMC) clinics. RESEARCH DESIGN. Quality of care was assessed using medical record data abstracted at CBOCs and VAMCs. The analysis used a logistic regression model that allowed for possible within-facility correlation and controlled for patient differences between facilities. SUBJECTS. The study included 4768 patients from 20 geographically diverse CBOCs and 2433 patients from the 20 VAMCs associated with these CBOCs. MEASURES. Quality of care was measured using 7 Prevention Index (PI) indicators and 9 Chronic Disease Care Index (CDCI) indicators, which assess compliance with nationally recognized guidelines for primary prevention, early disease detection, and care of patients with chronic disease. RESULTS. In the overall CBOC versus VAMC comparisons, performance was not significantly different on 15 of the 16 PI and CDCI indicators. In the comparisons between individual CBOCs and VAMCs pairs, 5 out of 20 CBOCs performed significantly below the affiliated VAMC on 4 or more indicators. CONCLUSIONS. These results suggest that CBOCs overall are providing a similar level of quality of care as VAMCs based on the PI and CDCI, although performance at several individual CBOCs fell below their affiliated VAMC on some indicators. Therefore, it appears that CBOCs are a valid approach for providing quality primary care to veterans.