Quality of hospital medicine care in Veterans Affairs hospitals versus non-Veterans Affairs hospitals: A systematic review of comparative studies.

Abstract

The Veterans Health Administration (VA) cares for more than one million hospitalized Veterans each year. There is limited knowledge on how hospital medicine care in VA facilities compares with non-VA hospitals in terms of the Institute of Medicine domains of healthcare access, patient experience, quality, clinical outcomes, and cost. To perform a systematic review that compares hospital-based care in VA and non-VA settings with a focus on general medicine conditions typically cared for by hospitalists. We identified relevant articles across four databases from January 2015 to April 2025. Eligible studies were required to assess outcomes in any Institute of Medicine healthcare domain among Veterans receiving care in the VA for acute medical conditions. Relevant comparisons included outcomes of (1) Veterans receiving care in the community, or (2) members of the general population receiving care in the community. We identified 13 studies. VA care generally exhibited equal or better outcomes compared with non-VA care, especially in risk-adjusted mortality rates. Most process-of-care studies showed VA care to be as good as or better than non-VA care. Findings on readmissions and patient experience were mixed, with some early findings showing VA care lagging behind but improving significantly by 2021. However, few studies were completed after the passage of the 2018 MISSION Act, which significantly shifted hospitalizations to non-VA care. Most published studies of comparisons of quality-of-care show that Veterans receiving hospital medicine care from VA receive the same or better quality care than Veterans getting community care.