Date: 1988-10-21
Speaker: BENJAMIN C. BRADLEE (democrat)
Chamber: S

Editor. the Washington Post. Washington. DC. DEAR MR. BRADLEZ: Your October 11. 1988 front page story headlined. "VA Researchers Ordered to Report Fewer Problem Hospitals." was a disappointment to those who regularly deal with the Post in good faith. and a disservice to the health care system that serves some of Americas most deserving patients. The storys false assertion that I ordered researchers to change the outcome of a VA study also came as a personal affront to someone who has spent an entire medical careerfrom working as a pathologist. to serving as dean of a medical school. to my current position as a federal health officialrespecting the importance and sanctity of medical research findings. But I was even more dismayed at the clearand totally unfoundedimplication that this VA study indicated VA facilities have higher mortality rates than other hospitals in the medical community at large. The fact is. no such comparisons can be made based on these studies. The VAs review of mortality used a statistical analysis which is of necessity different from the measurement technique used by the Health Care Financing Administration (HCFA) in reviewing mortality rates of Medicare pa. tients treated at community hospitals. Moreover. the report by HCFA was careful to point out that there is as yet no concrete evidence to show whether mortality results are a valid indicator of quality of care. In an attempt to assist in answering that crucial question. the VA study is being carried beyond the point at which HCFA concluded its study and published the results. In an independent review of the methods used by VA and HCFA. the General Accounting Office (GAO) noted this distinction and praised VAs methodology. It is significant that all VA medical centers hold the highest mark of approval currently available to any hospital in Amer"a. in the form of full accreditation from the Joint Commission on Accreditation of Health Care Organizations. I personally ordered that this mortality analysis be conducted when HCFA announced. In August 1987. its analytic model for assessing the mortality experience of Medicare patients. We were not directed to undertake this mortality analysis. but did so wholly on our own initiative in order to see whether this additional quality review tool might help us identify any problems in VA quality so that we could correct them. The VA is now validating the methodology by analyzing. through peer review. a statistical sample of medical records from the medical centers that were identified for review in the first phase of the study. When this followup process (also complimented by GAO and referred to as a "validation effort") is completed. we will publish the full report. and take steps to correct any quality problems so identified. We expect that our report will also make a contribu. tion to answering the crucial question of whether a mortality analysis model is a useful screening tool to indicate which hospitals do in fact have problems with quality. VA evidence on this point would be a significant contribution to the broader medical community. Dr. Francis E. Conrad. former Director of the Office of Quality Assurance. and I agreed that the effort devoted to this analysis was Justified as an exploration of a new approach which might improve our ability to review and them improve quality of care. Instead of focusing on that. however. your reported chose to write a different kind of story. by misquoting. skewing and ignoring the facts about a very complex study process. and sensationalizing some sketchy infor. mation obtained somehow from the files of a deceased VA colleague. In spite of the complexity of the matter. two simple facts stand out: 1. As Chief Medical Director. I personally initiated this study to see if it could identify problems in VA care so that they could then be corrected. The study continues on that basis. I want VA hospitals to be good. not just "look" good. 2. Although your reporter apparently has little understanding of the whole effort. a review by competent and independent analysts from the General Accounting Office led to praise for the VA. I believe such important subjects as veter. ans health care and these pioneering efforts to obtain objective evidence of medical care quality deserve more credible reporting. Sincerely.