title: Quality of pancreatic cancer care at Veterans Administration compared with non-Veterans Administration hospitals.
abstract: BACKGROUND
  National efforts are underway to monitor the quality of patient care at Veterans Administration (VA) hospitals. The objective of this study was to examine treatment utilization and outcomes for localized pancreatic cancer at VA compared with non-VA hospitals.
  
  
  METHODS
  Using the National Cancer Data Base, patients with pretreatment clinical stage I/II pancreatic adenocarcinoma were identified. Treatment utilization and outcomes were assessed at VA compared with academic and community hospitals.
  
  
  RESULTS
  Of 35,009 patients, 2% were seen at VA, 38% at academic, and 54% at community hospitals. VA hospitals were more likely to use surgery (odds ratio 2.20, 95% confidence interval 1.73-2.79) and to administer adjuvant chemotherapy (odds ratio 1.77, confidence interval 1.28-2.46) compared with community hospitals. Adjusted perioperative mortality and 3-year survival rates after surgery were similar at VA and academic hospitals.
  
  
  CONCLUSIONS
  For localized pancreatic cancer, patients treated at VA hospitals receive stage-specific treatments and have risk-adjusted perioperative and long-term survival rates that are comparable with those for patients treated at academic centers.
authors.affiliation: Department of Surgery, Feinberg School of Medicine, Northwestern University, 675 N. St. Clair St, Galter 10-105, Chicago, IL 60611, USA.
authors.forename: Karl Y
authors.initials: KY
authors.lastname: Bilimoria
authors.forename: David J
authors.initials: DJ
authors.lastname: Bentrem
authors.forename: James S
authors.initials: JS
authors.lastname: Tomlinson
authors.forename: Ryan P
authors.initials: RP
authors.lastname: Merkow
authors.forename: Andrew K
authors.initials: AK
authors.lastname: Stewart
authors.forename: Clifford Y
authors.initials: CY
authors.lastname: Ko
authors.forename: Jay B
authors.initials: JB
authors.lastname: Prystowsky
authors.forename: Mark S
authors.initials: MS
authors.lastname: Talamonti
mesh_terms: D000046:Academic Medical Centers / Q000592:standards; D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D005260:Female; D006764:Hospitals, Community / Q000592:standards; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery / Q000628:therapy*; D011787:Quality of Health Care; D016019:Survival Analysis; D016896:Treatment Outcome