Quality of Care for Older Patients With Cancer in the Veterans Health Administration Versus the Private Sector A Cohort Study
Quality of Care for Older Patients With Cancer in the Veterans Health Administration Versus the Private Sector A Cohort Study
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DOI：
10.7326/0003-4819-154-11-201106070-00004
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发表时间：
2011-06-07
影响因子：
39.2
通讯作者：
McNeil, Barbara J.
中科院分区：
文献类型：
--
作者：
Keating, Nancy L.;Landrum, Mary Beth;McNeil, Barbara J.
背景：退伍军人健康管理局 (VHA) 是美国最大的综合医疗保健系统。研究表明，VHA 为某些慢性疾病提供比私营部门更好的预防性护理和护理。目的：评估 VHA 与按服务收费医疗保险相比为老年患者提供的癌症护理质量。设计：对 2001 年至 2004 年诊断出的癌症患者进行观察性研究，并随访至 2005 年。地点：VHA 和非 VHA 医院和办公室诊所。患者：发生事件的 65 岁以上男性 结直肠癌、肺癌或前列腺癌；淋巴瘤；测量：结直肠癌、肺癌或前列腺癌的护理过程率；淋巴瘤；或多发性骨髓瘤。结果：与按服务收费的医疗保险人群相比，VHA 人群在早期接受了结肠癌（P < 0.001）和直肠癌（P = 0.007）的诊断，并且结肠癌根治性手术的调整率更高（92.7% vs. 90.5%；P < 0.010）、弥漫性大 B 细胞非霍奇金标准化疗。淋巴瘤 （71.1% vs. 59.3%；P < 0.001），以及双磷酸盐治疗多发性骨髓瘤（62.1% vs. 50.4%；P < 0.001）。 VHA 人群对采用外照射放射治疗的前列腺癌进行 3 维适形或调强放射治疗的调整率较低（61.6% 对比 86.0%；P < 0.001）。其他 9 项措施的调整后利率类似。敏感性分析表明，如果 VHA 系统中的癌症患者比其他患者有更严重的合并症，则 VHA 人群中大多数指标的发生率将高于按服务收费医疗保险人群。 局限性：这项研究仅包括老年男性，不包括有关体能状态、合并症严重程度或患者偏好的信息。 结论：VHA 系统中对老年癌症男性的护理通常与按服务收费的护理相似或更好 医疗保险受益人，尽管 VHA 系统可能会延迟采用一些昂贵的新技术。
Background: The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. Studies suggest that the VHA provides better preventive care and care for some chronic illnesses than does the private sector.Objective: To assess the quality of cancer care for older patients provided by the VHA versus fee-for-service Medicare.Design: Observational study of patients with cancer that was diagnosed between 2001 and 2004 who were followed through 2005.Setting: VHA and non-VHA hospitals and office-based practices.Patients: Men older than 65 years with incident colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma.Measurements: Rates of processes of care for colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. Rates were adjusted by using propensity score weighting.Results: Compared with the fee-for-service Medicare population, the VHA population received diagnoses of colon (P < 0.001) and rectal (P = 0.007) cancer at earlier stages and had higher adjusted rates of curative surgery for colon cancer (92.7% vs. 90.5%; P < 0.010), standard chemotherapy for diffuse large B-cell non-Hodgkin lymphoma (71.1% vs. 59.3%; P < 0.001), and bisphosphonate therapy for multiple myeloma (62.1% vs. 50.4%; P < 0.001). The VHA population had lower adjusted rates of 3-dimensional conformal or intensity-modulated radiation therapy for prostate cancer treated with external-beam radiation therapy (61.6% vs. 86.0%; P < 0.001). Adjusted rates were similar for 9 other measures. Sensitivity analyses suggest that if patients with cancer in the VHA system have more severe comorbid illness than other patients, rates for most indicators would be higher in the VHA population than in the fee-for-service Medicare population.Limitation: This study included only older men and did not include information about performance status, severity of comorbid illness, or patient preferences.Conclusion: Care for older men with cancer in the VHA system was generally similar to or better than care for fee-for-service Medicare beneficiaries, although adoption of some expensive new technologies may be delayed in the VHA system.