title: Patient characteristics associated with the level of patient-reported care coordination among male patients with colorectal cancer in the Veterans Affairs health care system.
abstract: BACKGROUND
  The current study was performed to determine whether patient characteristics, including race/ethnicity, were associated with patient-reported care coordination for patients with colorectal cancer (CRC) who were treated in the Veterans Affairs (VA) health care system, with the goal of better understanding potential goals of quality improvement efforts aimed at improving coordination.
  
  
  METHODS
  The nationwide Cancer Care Assessment and Responsive Evaluation Studies survey involved VA patients with CRC who were diagnosed in 2008 (response rate, 67%). The survey included a 4-item scale of patient-reported frequency ("never," "sometimes," "usually," and "always") of care coordination activities (scale score range, 1-4). Among 913 patients with CRC who provided information regarding care coordination, demographics, and symptoms, multivariable logistic regression was used to examine odds of patients reporting optimal care coordination.
  
  
  RESULTS
  VA patients with CRC were found to report high levels of care coordination (mean scale score, 3.50 [standard deviation, 0.61]). Approximately 85% of patients reported a high level of coordination, including the 43% reporting optimal/highest-level coordination. There was no difference observed in the odds of reporting optimal coordination by race/ethnicity. Patients with early-stage disease (odds ratio [OR], 0.60; 95% confidence interval [95% CI], 0.45-0.81), greater pain (OR, 0.97 for a 1-point increase in pain scale; 95% CI, 0.96-0.99), and greater levels of depression (OR, 0.97 for a 1-point increase in depression scale; 95% CI, 0.96-0.99) were less likely to report optimal coordination.
  
  
  CONCLUSIONS
  Patients with CRC in the VA reported high levels of care coordination. Unlike what has been reported in settings outside the VA, there appears to be no racial/ethnic disparity in reported coordination. However, challenges remain in ensuring coordination of care for patients with less advanced disease and a high symptom burden. Cancer 2015;121:2207-2213. © 2015 American Cancer Society.
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Division of General Internal Medicine, Duke University, Durham, North Carolina.
authors.forename: George L
authors.initials: GL
authors.lastname: Jackson
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Division of General Internal Medicine, Duke University, Durham, North Carolina.
authors.forename: Leah L
authors.initials: LL
authors.lastname: Zullig
authors.affiliation: Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Sean M
authors.initials: SM
authors.lastname: Phelan
authors.affiliation: Center for Health Services Research in Primary Care, Durham Veterans Affairs Medical Center, Durham, North Carolina.|Division of Gastroenterology, Duke University, Durham, North Carolina.
authors.forename: Dawn
authors.initials: D
authors.lastname: Provenzale
authors.affiliation: Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota.
authors.forename: Joan M
authors.initials: JM
authors.lastname: Griffin
authors.affiliation: Patient-Centered Outcomes Research Institute, Washington, DC.
authors.forename: Steven B
authors.initials: SB
authors.lastname: Clauser
authors.affiliation: Center for Health Information and Communication, Roudebush Veterans Affairs Medical Center, Indianapolis, Indiana.|Division of General Internal Medicine and Geriatrics, Indiana University, Indianapolis, Indiana.
authors.forename: David A
authors.initials: DA
authors.lastname: Haggstrom
authors.affiliation: Walter Reed National Military Medical Center, Bethesda, Maryland.
authors.forename: Rahul M
authors.initials: RM
authors.lastname: Jindal
authors.affiliation: Division of Health Care Policy & Research, Mayo Clinic, Rochester, Minnesota.
authors.forename: Michelle
authors.initials: M
authors.lastname: van Ryn
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis* / Q000208:ethnology*; D054625:Healthcare Disparities / Q000706:statistics & numerical data; D006801:Humans; D008297:Male; D005791:Patient Care / Q000379:methods*; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs / Q000706:statistics & numerical data*; D014728:Veterans / Q000706:statistics & numerical data*
keywords: care coordination; colorectal cancer; health disparities; veterans