Study: VA bests manages care in diabetes

August 23, 2004 PHILADELPHIA - Diabetic patients cared for by the Department of Veterans Affairs are more likely to receive recommended tests and have better outcomes than managed-care patients with diabetes, according to a new study. Researchers followed 1,285 patients with diabetes treated at five VA medical centers and 6,920 patients in eight commercial managed care health plans to see who received standard recommended tests, including eye exams, cholesterol screenings, foot exams, urine analyses and hemoglobin tests. 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. The statistics were adjusted to accommodate variations in the patients, said the study's lead author, Dr. Eve Kerr, who pointed out that VA patients often are older, poorer, sicker and more likely to be male than patients in managed care. "The VA has made great strides in the past 10 years," said Kerr. "What this tells us is that a nationally funded health care system can provide excellent quality of care." In 1995, the VA began to transform itself from a hospital operator to a health care provider with community-based medical and residential facilities and outpatient services. It also implemented electronic data collection to uniformly gather and store patient information, established treatment standards and monitored whether goals were being met, according to the Associated Press. The study was published in the Annals of Internal Medicine and 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 goal now is to find ways to apply some of the VA's successes in improving chronic disease treatment to smaller health care groups and private practices, said an editorial accompanying the study. "It's an almost heroic effort, what the VA has done," said Dr. Sheldon Greenfield of the University of California, Irvine, who was not connected to the study, to the Associated Press. "Many of the elements that it has implemented can be brought to other settings."