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首页> 外文期刊>Archives of Internal Medicine >Use of recommended ambulatory care services: is the Veterans Affairs quality gap narrowing?
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Use of recommended ambulatory care services: is the Veterans Affairs quality gap narrowing?

机译：使用推荐的门诊服务:是退伍军人事务部质量差距缩小?

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BACKGROUND: Veterans Affairs medical centers (VAMCs) provide better preventive and chronic disease care when compared with other health care organizations, although recent health care quality improvement initiatives outside the VAMC sector may have narrowed quality differences. METHODS: Using the nationally representative 2000 and 2004 surveys of the Behavior Risk Factor Surveillance System, which included 152,310 community-dwelling insured adults in 2000 and 251,570 in 2004, we compared self-reported use of 17 recommended ambulatory care services for cancer prevention, cardiovascular risk reduction, diabetes mellitus management, and infectious disease prevention among insured adults receiving and not receiving care at VAMCs. RESULTS: A total of 2852 insured adults (1.9%) received care at VAMCs in 2000 and 7155 (2.4%) received care at VAMCs in 2004. Use of 9 of the 17 services was greater in 2004 when compared with 2000 (P < or = .05). In 2000, receiving VAMC care was associated with greater use of 6 of the 17 services; in 2004, receiving VAMC care was associated with greater use of 12 of the 17 services (P < or = .05). In 2004, greater use among these 12 services ranged from 10% greater use of cholesterol screening to 40% greater use of colorectal cancer screening. For 13 of the 17 services, the likelihood of service use among adults receiving VAMC care when compared with adults not receiving VAMC care was not significantly different in 2004 than in 2000. However, this likelihood was significantly greater (for VAMC vs non-VAMC use) in 2004 than in 2000 for breast cancer screening (relative risk [RR], 1.21 [95% confidence interval {CI}, 1.15-1.25] vs 0.80 [95% CI, 0.58-0.98]; P < .001), dilated eye examination among adults with diabetes (RR, 1.12 [95% CI, 1.07-1.15] vs 1.01 [95% CI, 0.88-1.09]; P = .04), and influenza (RR, 1.30 [95% CI, 1.24-1.36] vs 1.06 [95% CI, 0.89-1.21]; P = .006) and pneumococcal (RR, 1.27 [95% CI, 1.23-1.31] vs 1.04 [95% CI, 0.86-1.21]; P = .005) vaccinations. CONCLUSION: Despite increasing emphasis on quality of care and improved performance throughout the US health care system, adults receiving VAMC care remain more likely to receive recommended ambulatory care.
机译：背景:退伍军人医疗中心(VAMCs)提供更好的预防和慢性疾病与其他医疗保健相比组织,尽管最近的卫生保健VAMC之外的质量改进措施部门可能缩小质量差异。方法:利用2000年全国代表性和2004年的调查行为危险因素监测系统,其中包括152310年社区保险成年人和2000年相比251570年的2004,我们自我报告的使用17推荐门诊服务预防癌症,降低心血管疾病的风险,糖尿病管理和传染性疾病预防保险成年人接受而不是在VAMCs接受护理。2852年保险成人(1.9%)接受护理VAMCs在2000年和7155年(2.4%)接受护理2004年VAMCs。更在2004年与2000年相比(P < =. 05)。更多地使用6的17个服务;2004年,接受VAMC保健与更多地使用12的17服务(P < =. 05)。服务范围从10%更大的使用使用更多的胆固醇检测到40%结直肠癌筛查。服务,服务中使用的可能性相比成年人接受VAMC护理成年人不接收VAMC关心不是2004年比2000年明显不同。然而,这可能是显著的更大的(VAMC vs non-VAMC使用)比2004年2000年乳腺癌筛查(相对风险(RR), 1.21(95%置信区间CI {},1.15 - -1.25)和0.80 (95% CI, 0.58 - -0.98);成年人措施),扩张眼睛检查糖尿病(RR, 1.12(95%可信区间,1.07 - -1.15)和1.01(95% CI, 0.88 - -1.09);0.89 - -1.21);P = .005)疫苗。强调护理和质量改进的性能在整个我们的健康成人保健系统,接收VAMC护理仍然存在更容易接受推荐的动态护理。

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