title: Quality of colorectal cancer care among veterans: a 10-year retrospective cohort.
abstract: BACKGROUND
  Nearly 5,000 patients within Veterans Health Administration (VHA) are diagnosed with colorectal cancer (CRC) annually. However, the link between performance on CRC practice guidelines and outcomes is unclear. The purpose of this study was to evaluate quality of CRC care by assessing adherence to National Comprehensive Cancer Network (NCCN) guidelines and to determine if receipt of these metrics was associated with improvement in mortality.
  
  
  METHODS
  We performed a retrospective cohort study of all patients who underwent resection for nonmetastatic CRC at VHA Tennessee Valley Healthcare System from 2001 to 2010. We defined "excellent" care as receipt of at least 75 % of eligible NCCN metrics. We also examined time to treatment and the relationship between excellent care and mortality.
  
  
  RESULTS
  A total of 331 patients underwent resection for CRC within the study period. Only 47 % of patients received excellent care, and 9 % received 100 % of eligible metrics. The median time from diagnosis to definitive treatment was 22 days [interquartile range (IQR) 12, 41] and 37 days (IQR 24, 56) among colon and rectal cancer patients, respectively. The likelihood of receiving excellent care increased significantly over time. However, there was no association between receipt of excellent care and 5-year all-cause mortality [hazard ratio (HR) 0.85; 95 % CI 0.53-1.36].
  
  
  CONCLUSIONS
  Although patients received timely care overall, fewer than half of CRC patients received at least 75 % of eligible NCCN metrics. Although receipt of excellent care was not associated with reduction in all-cause mortality, further research is necessary to identify quality metrics likely to influence patient outcomes.
authors.affiliation: Veterans Health Administration-Tennessee Valley Healthcare System, Geriatric Research Education and Clinical Center (GRECC), HSR&D Center, Nashville, TN, USA, rebecca.snyder@vanderbilt.edu.
authors.forename: Rebecca A
authors.initials: RA
authors.lastname: Snyder
authors.forename: Rajshri
authors.initials: R
authors.lastname: Mainthia
authors.forename: Ravi
authors.initials: R
authors.lastname: Patel
authors.forename: Robert S
authors.initials: RS
authors.lastname: Dittus
authors.forename: Christianne L
authors.initials: CL
authors.lastname: Roumie
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology / Q000628:therapy*; D005260:Female; D005500:Follow-Up Studies; D019983:Guideline Adherence; D006787:Hospitals, Veterans / Q000592:standards* / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D011379:Prognosis; D011785:Quality Assurance, Health Care; D012189:Retrospective Studies; D013997:Time Factors; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans / Q000706:statistics & numerical data*