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

Publication ,  Journal Article
Zullig, LL; Jackson, GL; Weinberger, M; Provenzale, D; Reeve, BB; Carpenter, WR
Published in: Clin Colorectal Cancer
December 2013

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.

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Published In

Clin Colorectal Cancer

DOI

EISSN

1938-0674

Publication Date

December 2013

Volume

12

Issue

4

Start / End Page

255 / 260

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Racial Groups
  • Outcome and Process Assessment, Health Care
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
NLM
Zullig, L. L., Jackson, G. L., Weinberger, M., Provenzale, D., Reeve, B. B., & Carpenter, W. R. (2013). An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system. Clin Colorectal Cancer, 12(4), 255–260. https://doi.org/10.1016/j.clcc.2013.06.004
Zullig, Leah L., George L. Jackson, Morris Weinberger, Dawn Provenzale, Bryce B. Reeve, and William R. Carpenter. “An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system.Clin Colorectal Cancer 12, no. 4 (December 2013): 255–60. https://doi.org/10.1016/j.clcc.2013.06.004.
Zullig LL, Jackson GL, Weinberger M, Provenzale D, Reeve BB, Carpenter WR. An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system. Clin Colorectal Cancer. 2013 Dec;12(4):255–60.
Zullig, Leah L., et al. “An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system.Clin Colorectal Cancer, vol. 12, no. 4, Dec. 2013, pp. 255–60. Pubmed, doi:10.1016/j.clcc.2013.06.004.
Zullig LL, Jackson GL, Weinberger M, Provenzale D, Reeve BB, Carpenter WR. An examination of racial differences in process and outcome of colorectal cancer care quality among users of the veterans affairs health care system. Clin Colorectal Cancer. 2013 Dec;12(4):255–260.
Journal cover image

Published In

Clin Colorectal Cancer

DOI

EISSN

1938-0674

Publication Date

December 2013

Volume

12

Issue

4

Start / End Page

255 / 260

Location

United States

Related Subject Headings

  • Veterans
  • United States Department of Veterans Affairs
  • United States
  • Retrospective Studies
  • Racial Groups
  • Outcome and Process Assessment, Health Care
  • Oncology & Carcinogenesis
  • Middle Aged
  • Male
  • Humans