title: Quality of supportive care for patients with advanced lung cancer in the Veterans Health Administration.
abstract: BACKGROUND
  Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care.
  
  
  OBJECTIVE
  To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality.
  
  
  METHODS
  We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care.
  
  
  CONCLUSIONS
  Not all supportive care was evaluated. Care processes identified as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient's care to the correct facility.
  
  
  CONCLUSIONS
  Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confirmed high-quality supportive care, while identifying significant facility-level variation in VHA.
authors: Veterans Administration Greater Los Angeles Healthcare System, West Los Angeles, Los Angeles, California, USA. sabine.oishi@va.gov.
authors: Sabine M
authors: SM
authors: Oishi
authors: Veterans Administration Greater Los Angeles Healthcare System, West Los Angeles, Los Angeles, California, USA; and Fielding School of Public Health, Department of Biostatistics, University of California, Los Angeles, California, USA.
authors: Anna Liza M
authors: AL
authors: Antonio
authors: Department of Radiation Oncology, Kaiser Permanente Los Angeles Medical Center, Los Angeles, California, USA.
authors: Joan
authors: J
authors: Ryoo
authors: Office of Informatics and Analytics, Veterans Health Administration, Washington, DC, USA.
authors: Diana L
authors: DL
authors: Ordin
authors: Veterans Administration Greater Los Angeles Healthcare System, West Los Angeles, Los Angeles, California, USA.
authors: Karl A
authors: KA
authors: Lorenz
authors: Fielding School of Public Health, Department of Biostatistics, University of California, Los Angeles, California, USA.
authors: Ren
authors: R
authors: He
authors: Veterans Administration Palo Alto Health Care System; Palo Alto, California, USA; and Division of General Medical Disciplines, Stanford University, Stanford, California, USA.
authors: Steven M
authors: SM
authors: Asch
authors: Division of Hematology/Oncology, Department of Medicine, University of California, San Francisco, California, USA.
authors: Benjamin
authors: B
authors: Kim
authors: Veterans Administration Greater Los Angeles Healthcare System, West Los Angeles, Los Angeles, California, USA; and Jonsson Comprehensive Cancer Center, University of California, Los Angeles, California, USA.
authors: Jennifer
authors: J
authors: Malin
keywords: Quality indicators; lung cancer; palliative care; quality improvement