title: Examining potential colorectal cancer care disparities in the Veterans Affairs health care system.
abstract: OBJECTIVE
  Racial disparities in cancer treatment and outcomes are a national problem. The nationwide Veterans Affairs (VA) health system seeks to provide equal access to quality care. However, the relationship between race and care quality for veterans with colorectal cancer (CRC) treated within the VA is poorly understood. We examined the association between race and receipt of National Comprehensive Cancer Network guideline-concordant CRC care.
  
  
  METHODS
  This was an observational, retrospective medical record abstraction of patients with CRC treated in the VA. Two thousand twenty-two patients (white, n = 1,712; African American, n = 310) diagnosed with incident CRC between October 1, 2003, and March 31, 2006, from 128 VA medical centers, were included. We used multivariable logistic regression to examine associations between race and receipt of guideline-concordant care (computed tomography scan, preoperative carcinoembryonic antigen, clear surgical margins, medical oncology referral for stages II and III, fluorouracil-based adjuvant chemotherapy for stage III, and surveillance colonoscopy for stages I to III). Explanatory variables included demographic and disease characteristics.
  
  
  RESULTS
  There were no significant racial differences for receipt of guideline-concordant CRC care. Older age at diagnosis was associated with reduced odds of medical oncology referral and surveillance colonoscopy. Presence of cardiovascular comorbid conditions was associated with reduced odds of medical oncology referral (odds ratio, 0.65; 95% CI, 0.50 to 0.89).
  
  
  CONCLUSIONS
  In these data, we observed no evidence of racial disparities in CRC care quality. Future studies could examine causal pathways for the VA's equal, quality care and ways to translate the VA's success into other hospital systems.
authors.affiliation: Leah L. Zullig, Dawn Provenzale, Morris Weinberger, and George L. Jackson, Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center; Dawn Provenzale and George L. Jackson, Duke University, Durham; and Leah L. Zullig, William R. Carpenter, Morris Weinberger, and Bryce B. Reeve, University of North Carolina at Chapel Hill, Chapel Hill, NC.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
mesh_terms: D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000369:Aged, 80 and over; D003113:Colonoscopy; D015179:Colorectal Neoplasms / Q000453:epidemiology* / Q000628:therapy; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D054625:Healthcare Disparities / Q000639:trends*; D006801:Humans; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D012189:Retrospective Studies; D014481:United States / Q000453:epidemiology; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*; D044465:White People / Q000706:statistics & numerical data