Efficiency of Colorectal Cancer Care Among Veterans: Analysis of Treatment Wait Times at Veterans Affairs Medical Centers
Efficiency of Colorectal Cancer Care Among Veterans: Analysis of Treatment Wait Times at Veterans Affairs Medical Centers
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DOI：
10.1200/jop.2012.000738
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发表时间：
2013-07-01
影响因子：
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通讯作者：
Bentrem, David J.
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文献类型：
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作者：
Merkow, Ryan P.;Bilimoria, Karl Y.;Bentrem, David J.
目的：癌症治疗的及时性是医疗保健质量的一个重要方面。退伍军人事务医疗中心（VAMC）预计将治疗越来越多的癌症患者。我们的目标是检查治疗时间从诊断到第一疗程治疗的结肠癌和直肠癌患者，并评估与长期等待times.Methods：从VA中央癌症登记处，谁接受了结肠或直肠切除术的癌症患者从1998年至2008年确定的因素。测量从诊断到确定性癌症导向治疗的时间，并使用多变量回归方法来确定结肠癌（> 45天）和直肠癌（> 60天）等待时间延长的预测因素。结果：在124例VAMC中，14，097例患者接受了结肠切除术，3，390例患者接受了直肠切除术。对于结肠癌，中位治疗时间随时间增加了68%（P < .001）。从2007年到2008年，结肠切除术的平均时间为32天。等待时间延长的预测因素包括年龄> 55岁（v < 55岁）、时间段（2007年至2008年v 1998年至2000年）、黑人（v白色）、婚姻状况（已婚v未婚）、高容量中心状态（v低容量）和在不同医院治疗（v初始诊断为同一医院;所有P <0.05）。对于直肠癌，第一疗程治疗的总体中位时间增加了74%（P <0.001）。从2007年到2008年，直肠切除术的平均时间为47天。直肠癌的等待时间延长的类似预测因素被确定为rectal cancel.Conclusion：首次治疗的时间增加了结肠癌和直肠癌患者在VAMC。患者、肿瘤和医院因素与治疗时间延长相关。
Purpose: Timeliness of cancer treatment is an important aspect of health care quality. Veterans Affairs Medical Centers (VAMCs) are expected to treat a growing number of patients with cancer. Our objectives were to examine treatment times from diagnosis to first-course therapy for patients with colon and rectal cancers and assess factors associated with prolonged wait times.Methods: From the VA Central Cancer Registry, patients who underwent colon or rectal resection for cancer from 1998 to 2008 were identified. Time from diagnosis to definitive cancer-directed therapy was measured, and multivariable regression methods were used to determine predictors of prolonged wait times for colon (> 45 days) and rectal (> 60 days) cancers.Results: From 124VAMCs, 14,097 patients underwent colectomy, and 3,390 underwent rectal resection for cancer. For colon cancer, the median time to treatment increased by 68% over time (P < .001). From 2007 to 2008, the median time to colectomy was 32 days. Predictors of prolonged wait times included age > 55 years (v < 55 years), time period (2007 to 2008 v 1998 to 2000), black race (v white), marriage status (married v unmarried), high-volume center status (v low volume), and treatment at a different hospital (v same hospital as initial diagnosis; all P < .05). For rectal cancer, the overall median time to first-course treatment increased by 74% (P < .001). From 2007 to 2008, the median time to proctectomy was 47 days. Similar predictors of prolonged wait times were identified for rectal cancer.Conclusion: Time to first treatment has increased for patients with colon and rectal cancers at VAMCs. Patient, tumor, and hospital factors are associated with prolonged time to treatment.