Fig. 4

Undertreatment rates over time among facilities with lowest rates of overtreatment (dashed lines) and the average rate among all VA facilities (solid line); the shaded area represents the 95th percentile confidence interval.The upper panel shows results from the at risk population and the lower panel shows the response in the population not at high risk. Eight facilities (labeled with letters) were identified as high performers in 2009 using overtreatment metrics; but low overtreatment observed in a facility with high rates of undertreatment is of concern. Looking at the undertreatment rates over time of the flagged overtreatment facilities and comparing them to the undertreatment rates of all VA facilities, several high performers with regard to overtreatment have consistently high rates of undertreatment