An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system


Journal Article

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). Patients and 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). Conclusion 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. © 2013 Elsevier Inc. All rights reserved.

Full Text

Duke Authors

Cited Authors

  • Zullig, LL; Jackson, GL; Weinberger, M; Provenzale, D; Reeve, BB; Carpenter, WR

Published Date

  • December 1, 2013

Published In

Volume / Issue

  • 12 / 4

Start / End Page

  • 255 - 260

Electronic International Standard Serial Number (EISSN)

  • 1938-0674

International Standard Serial Number (ISSN)

  • 1533-0028

Digital Object Identifier (DOI)

  • 10.1016/j.clcc.2013.06.004

Citation Source

  • Scopus