Ensuring Optimal Adjustment for Determinations of Institutional Quality

To the Editor Groeneveld et al¹ explored variation in risk-standardized mortality for congestive heart failure and ischemic heart disease using administrative data across Veterans Affairs (VA) hospitals. The authors found significant variation in mortality across facilities, with nearly 2-fold differences in both disease states. These findings raise concerns given the VA’s goal to ensure high-quality care throughout the largest integrated health care system in the United States.