title: Quality of prostate cancer care among rural men in the Veterans Health Administration.
abstract: BACKGROUND
  Patient travel distances, coupled with variation in facility-level resources, create barriers for prostate cancer care in the Veterans Health Administration integrated delivery system. For these reasons, the authors investigated the degree to which these barriers impact the quality of prostate cancer care.
  
  
  METHODS
  The Veterans Affairs Central Cancer Registry was used to identify all men who were diagnosed with prostate cancer in 2008. Patient residence was characterized using Rural Urban Commuting Area codes. The authors then examined whether rural residence, compared with urban residence, was associated with less access to cancer-related resources and worse quality of care for 5 prostate cancer quality measures.
  
  
  RESULTS
  Approximately 25% of the 11,368 patients who were diagnosed with prostate cancer in 2008 lived in either a rural area or a large town. Rural patients tended to be white (62% urban vs 86% rural) and married (47% urban vs 63% rural), and they tended to have slightly higher incomes (all P<.01) but similar tumor grade (P=.23) and stage (P=.12) compared with urban patients. Rural patients were significantly less likely to be treated at facilities with comprehensive cancer resources, although they received a similar or better quality of care for 4 of the 5 prostate cancer quality measures. The time to prostate cancer treatment was similar (rural patients vs urban patients, 96.6 days vs 105.7 days).
  
  
  CONCLUSIONS
  Rural patients with prostate cancer had less access to comprehensive oncology resources, although they received a similar quality of care, compared with their urban counterparts in the Veterans Health Administration integrated delivery system. A better understanding of the degree to which facility factors contribute to the quality of cancer care may assist other organizations involved in rural health care delivery.
authors.affiliation: Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
authors.forename: Ted A
authors.initials: TA
authors.lastname: Skolarus
authors.forename: Stephanie
authors.initials: S
authors.lastname: Chan
authors.forename: Jeremy B
authors.initials: JB
authors.lastname: Shelton
authors.forename: Anna Liza
authors.initials: AL
authors.lastname: Antonio
authors.forename: Anne E
authors.initials: AE
authors.lastname: Sales
authors.forename: Jennifer L
authors.initials: JL
authors.lastname: Malin
authors.forename: Christopher S
authors.initials: CS
authors.lastname: Saigal
mesh_terms: D000368:Aged; D003695:Delivery of Health Care; D005500:Follow-Up Studies; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D011379:Prognosis; D011471:Prostatic Neoplasms / Q000453:epidemiology / Q000473:pathology / Q000628:therapy*; D011787:Quality of Health Care / Q000706:statistics & numerical data*; D012424:Rural Population / Q000706:statistics & numerical data*; D015996:Survival Rate; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D058014:Veterans Health
keywords: access; integrated delivery system; prostate cancer; quality; rural