title: Quality of care for older patients with cancer in the Veterans Health Administration versus the private sector: a cohort study.
abstract: 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.
  
  
  METHODS
  Observational study of patients with cancer that was diagnosed between 2001 and 2004 who were followed through 2005.
  
  
  METHODS
  VHA and non-VHA hospitals and office-based practices.
  
  
  METHODS
  Men older than 65 years with incident colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma.
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  This study included only older men and did not include information about performance status, severity of comorbid illness, or patient preferences.
  
  
  CONCLUSIONS
  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.
  
  
  BACKGROUND
  Department of Veterans Affairs.
authors.affiliation: Brigham and Women's Hospital, Harvard Medical School, Massachusetts General Hospital Cancer Center, Boston, Massachusetts, USA. keating@hcp.med.harvard.edu
authors.forename: Nancy L
authors.initials: NL
authors.lastname: Keating
authors.forename: Mary Beth
authors.initials: MB
authors.lastname: Landrum
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Lamont
authors.forename: Samuel R
authors.initials: SR
authors.lastname: Bozeman
authors.forename: Steven H
authors.initials: SH
authors.lastname: Krasnow
authors.forename: Lawrence N
authors.initials: LN
authors.lastname: Shulman
authors.forename: Jennifer R
authors.initials: JR
authors.lastname: Brown
authors.forename: Craig C
authors.initials: CC
authors.lastname: Earle
authors.forename: William K
authors.initials: WK
authors.lastname: Oh
authors.forename: Michael
authors.initials: M
authors.lastname: Rabin
authors.forename: Barbara J
authors.initials: BJ
authors.lastname: McNeil
mesh_terms: D000368:Aged; D019033:Delivery of Health Care, Integrated / Q000592:standards*; D018588:Fee-for-Service Plans / Q000592:standards; D006787:Hospitals, Veterans / Q000592:standards; D006801:Humans; D008297:Male; D006278:Medicare / Q000592:standards*; D009369:Neoplasms / Q000628:therapy*; D017149:Private Sector / Q000592:standards; D057216:Propensity Score; D019984:Quality Indicators, Health Care; D014481:United States; D014493:United States Department of Veterans Affairs / Q000592:standards*