title: Comparing the Quality of Ambulatory Surgical Care for Skin Cancer in a Veterans Affairs Clinic and a Fee-For-Service Practice Using Clinical and Patient-Reported Measures.
abstract: The Institute of Medicine has identified serious deficiencies in the measurement of cancer care quality, including the effects on quality of life and patient experience. Moreover, comparisons of quality in Veterans Affairs Medical Centers (VA) and other sites are timely now that many Veterans can choose where to seek care. To compare quality of ambulatory surgical care for keratinocyte carcinoma (KC) between a VA and fee-for-service (FFS) practice, we used unique clinical and patient-reported data from a comparative effectiveness study. Patients were enrolled in 1999-2000 and followed for a median of 7.2 years. The practices differed in a few process measures (e.g., median time between biopsy and treatment was 7.5 days longer at VA) but there were no substantial or consistent differences in clinical outcomes or a broad range of patient-reported outcomes. For example, 5-year tumor recurrence rates were equally low (3.6% [2.3-5.5] at VA and 3.4% [2.3-5.1] at FFS), and similar proportions of patients reported overall satisfaction at one year (78% at VA and 80% at FFS, P = 0.69). These results suggest that the quality of care for KC can be compared comprehensively in different health care systems, and suggest that quality of care for KC was similar at a VA and FFS setting.
authors.affiliation: Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Matthew P
authors.identifier: http://orcid.org/0000-0001-6747-5973
authors.initials: MP
authors.lastname: Dizon
authors.affiliation: Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Eleni
authors.initials: E
authors.lastname: Linos
authors.affiliation: Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America.|San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
authors.forename: Sarah T
authors.initials: ST
authors.lastname: Arron
authors.affiliation: Department of Biostatistics and Epidemiology, University of California San Francisco, San Francisco, California, United States of America.
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Hills
authors.affiliation: Program for Clinical Research, Department of Dermatology, University of California San Francisco, San Francisco, California, United States of America.|San Francisco Veterans Affairs Medical Center, San Francisco, California, United States of America.
authors.forename: Mary-Margaret
authors.identifier: http://orcid.org/0000-0001-8009-7014
authors.initials: MM
authors.lastname: Chren
mesh_terms: D000368:Aged; D000554:Ambulatory Care Facilities / Q000592:standards*; D018588:Fee-for-Service Plans / Q000592:standards*; D005260:Female; D006787:Hospitals, Veterans / Q000592:standards*; D006801:Humans; D053208:Kaplan-Meier Estimate; D015603:Keratinocytes / Q000473:pathology; D008297:Male; D017064:Process Assessment, Health Care; D058028:Research Report; D012878:Skin Neoplasms / Q000601:surgery*; D016896:Treatment Outcome; D014481:United States; D014493:United States Department of Veterans Affairs; D014728:Veterans