Outcome of myocardial infarction in Veterans Health Administration patients as compared with medicare patients.

Background: Some have the opinion that patients cared for in Veterans Healt h Administration (VHA) hospitals receive care of poorer quality than those cared for in non-VHA institutions. To assess the quality of care in VHA hos pitals, we compared the outcome of acute myocardial infarction among patien ts in VHA and non-VHA institutions while controlling for potential confound ers, including coexisting conditions and severity of illness. Methods: We studied 2486 veterans discharged from 81 VHA hospitals and 29,2 49 Medicare patients discharged from 1530 non-VHA hospitals, restricting ou r samples to men at least 65 years of age who were discharged with confirme d acute myocardial infarction. We compared coexisting conditions, severity of illness, and 30-day and 1-year mortality in the two samples. Results: VHA patients were significantly more likely than Medicare patients to have a recorded history of hypertension (64.3 percent vs. 57.3 percent) , chronic obstructive pulmonary disease or asthma (30.9 percent vs. 23.5 pe rcent), diabetes (34.8 percent vs. 29.0 percent), stroke (20.4 percent vs. 14.2 percent), or dementia (7.2 percent vs. 4.8 percent) (P<0.001 for all c omparisons). According to both multivariate logistic regression and an anal ysis using 2265 matched pairs of VHA and Medicare patients, there were no s ignificant differences in 30-day or 1-year mortality. The matched-pairs ana lysis found that the difference in mortality at 30 days (the mortality rate among Medicare patients minus the mortality rate among VHA patients), aver aged over the 5-year age groups, was -0.8 percent (95 percent confidence in terval, -2.8 to 1.3), and the difference in mortality at 1 year was -1.3 pe rcent (95 percent confidence interval, -3.9 to 1.3). Conclusions: VHA patients had more coexisting conditions than Medicare pati ents. Nevertheless, we found no significant difference in mortality between VHA and Medicare patients, a result that suggests a similar quality of car e for acute myocardial infarction. (N Engl J Med 2000;343:1934-41.) (C) 200 0, Massachusetts Medical Society.