# Presentation: 337908

## 

Steven M. Wright, PhD
Director of Epidemiology
Office of Quality and Performance

- Steven M. Wright, PhD
- Director of Epidemiology
*Office of Quality and Performance*

**An Analysis of the Quality of Care Provided to Men and Women **
**in the VA Health Care System**

## VA vs. Private Sector

| CLINICAL PERFORMANCE INDICATOR | VA FY 07 | VA FY 06 | HEDIS   Commercial 2006 | HEDIS         Medicare 2006 | HEDIS             Medicaid 2006 |
| --- | --- | --- | --- | --- | --- |
| Breast cancer screening | 86% | 85% | 69% | 70% | 49% |
| Cervical cancer screening  | 91% | 91% | 81% | NA | 66% |
| Colorectal cancer screening | 78% | 76% | 55% | 53% | NA |
| LDL Screening after AMI, PTCA, CABG | 93% | 92% | 87% | 88% | 76% |
| LDL Cholesterol < 100 after AMI, PTCA, CABG | 62% | 60% | 57% | 56% | 36% |
| Beta blocker on discharge after AMI | 98% | 98% | 98% | 94% | 88% |
| Diabetes: HgbA1c done past year | 97% | 96% | 88% | 87% | 78% |
| Diabetes: HbA1c > 9.0% (lower is better) | 16% | 17% | 27% | 27% | 49% |
| Diabetes: Cholesterol (LDL-C) Screening | 92% | 96% | 83% | 85% | 71% |
| Diabetes: Cholesterol (LDL-C) controlled (<100)  | 64% | 61% | 43% | 47% | 31% |
| Diabetes: Good Control HbA1c <7 | 48% | 47% | 42% | 46% | 30% |
| Diabetes: Eye Exam   | 85% | 85% | 55% | 62% | 51% |
| Diabetes: Renal Exam   | 91% | 66% | 80% | 85% | 75% |
| Diabetes: BP < 140/90  (VA 06 & 07 data is </=) | 77% | 78% | 61% | 58% | 57% |
| Hypertension: BP < 140/90 most recent visit  | 76% | 75% | 60% | 57% | 53% |
| Smoking Cessation Counseling | 83% | 80% | 74% | 44% | 43% |
| Immunizations: influenza | 72%                       (age 50-64) | 71%                                  (≥65r or high risk) | 46% | NA | 69.6%                                     (65 or high risk) |
| Immunizations: pneumococcal,  | 90%                          (all ages at risk) | 89%                      (all ages at risk) | Not Reported | Not Reported | 67% |

## MethodsEPRP FY07 Data Sources 

- NEXUS Outpatient Clinics
- Random sample all ages (~ 6% women)
- Women Augmented Sample
- Outpatient clinics (12K, ages 50-65)
- Inpatient cohorts
- AMI, CHF, CAP, Surgical
- Low number of women

## Age distribution or Women and Men in EPRP Sample FY07

**Age distribution or Women and Men in EPRP Sample FY07**

- Women

- Men

## FY07 Diabetes Outpatient Measures

**FY07 Diabetes Outpatient Measures**
**Difference Between Women and Men**

**Measures with higher score for women**

**Measures with lower **
**score for women**

- dmg25h    LDL-C <100 (HEDIS)
- dmg20      ASA included in current meds
- dmg26h    LDL-C <130 (HEDIS)
- dmg22      ACEI/ARB in current meds
- dmg34h    Renal testing (HEDIS)
- dmg31h    Retinal exam, timely by (HEDIS)
- dmg23h    HbA1C>9 or not done past yr (HEDIS)
- dmg27h    BP ≤140/90

## Slide 6

## AMI Outpatient Measures by Age

**AMI Outpatient Measures by Age**
**Difference Between Women and Men**

-    ASA               Beta Blocker       LDL<100 H         LVEF<40        Tobacco Use

## FY07 Hypertension Measures

**Difference Between Women and Men**

**No Difference:**
- htn9h     BP ≤ 140/90 (HEDIS) – DX HTN
- Htn9      BP ≤ 140/90 (HEDIS) – No DX HTN
**Favoring Women:**
- htn11     BP ≤140/90 - No Dx of HTN
**Favoring Men:**
- htn2n     Smoking past 12 months - HTN
- htn10     BP 160/100 or not recorded – DX HTN
- htn12     BP 160/100 or not recorded – No DX HTN

## FY07 Hypertension Measures by Age

**FY07 Hypertension Measures by Age**
**Difference Between Women and Men**

**      ****Tobacco         BP w/Dx_H**
**         ****Use                <=140/90**

## Immunization by Age

**Immunization by Age**
**Difference Between Women and Men**

**   **Pneumococcal       Influenza
-           Nexus               Nexus

## Screening Measures by Age

**Screening Measures by Age**
**Difference Between Women and Men**

- Depression            Colorectal              Alcohol
-                                 Cancer

## Hyperlipidemia Measure by Age

**Hyperlipidemia Measure by Age**
**Difference Between Women and Men**

- Non DM, Non AMI pts with LDL≥120

## Slide 13

## Difference Between at Risk Women and Men

- LDL < 100 by VISN     FY06-08Q1

## Difference Between at Risk Women and Men

- LDL < 100 by VAMC    FY06-08Q1

## AMI Patients on Lipid Lowering Medication by Adherence to LDL Measure by Age and Sex

## Relationship to Women’s Program

- Presence of designated women’s health providers in general primary care clinics not significantly associated with absence of a disparity between men and women on 38 measures.
- Single exception: women veterans over 65 years of age less likely to receive pneumococcal vaccination (69% vs 51%).

## Conclusions

- Generally quality of care for women quite high
- Significant (up to 20%) and durable gaps in outpatient care for women in relationship to:
- Management of cardiovascular risk factors including those with diabetes, HTN, IHD
- Colorectal cancer screening
- Immunization
- Depression Screening
- Age an important effect modifier
- Remarkable differences across VISNs and facilities
- No association with presence of designated women's health providers