title: An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system.
abstract: BACKGROUND
  Veterans Affairs (VA) manages the largest US integrated health care system. Although quality of VA colorectal cancer (CRC) care is well chronicled, there is a paucity of research examining racial differences in this care. This study examines racial differences in 2 dimensions of quality of VA CRC care: processes (time to treatment) and outcomes (survival).
  
  
  METHODS
  Retrospective data were from the VA External Peer Review Program (EPRP), a nationwide VA quality-monitoring program. Study patients were white and African American men diagnosed with nonmetastatic CRC between 2003 and 2006 who received definitive CRC surgery. We examined 3 quality indicators: time from (1) surgery to initiation of adjuvant chemotherapy (stages II-III disease), (2) surgery to surveillance colonoscopy (stages I-III disease), and (3) surgery to death (stages I-III disease). Unadjusted analyses used log-rank and Wilcoxon tests. Adjusted analyses used Cox proportional hazard models.
  
  
  RESULTS
  In unadjusted analyses, there was no evidence of racial differences across the 3 quality measures. In adjusted Cox regression, there were no racial differences in time to initiation of chemotherapy (hazard ratio [HR], 0.82; P = .61) or surgery to death (HR, 0.94; P = .49). In adjusted Cox regression, among those receiving colonoscopy within 7 to 18 months after surgery, white patients experienced slightly shorter median times to surveillance colonoscopy than did African American patients (367 vs. 383 days; HR, 0.63; P = .02).
  
  
  CONCLUSIONS
  Other than a small racial difference in timing of surveillance colonoscopy, there was little evidence of racial differences in quality of CRC care among VA health care system users.
authors.affiliation: Center of Excellence for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, NC; Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC. Electronic address: zullig@email.unc.edu.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
authors.forename: Morris
authors.initials: M
authors.lastname: Weinberger
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
authors.forename: Bryce B
authors.initials: BB
authors.lastname: Reeve
authors.forename: William R
authors.initials: WR
authors.lastname: Carpenter
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000208:ethnology*; D005260:Female; D054625:Healthcare Disparities / Q000208:ethnology*; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data
keywords: Colorectal neoplasms; Health care disparities; Health care quality; Minority health; US Veterans Affairs