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Nancy L Keating - One of the best experts on this subject based on the ideXlab platform.
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understanding variation in primary prostate cancer treatment within the veterans health administration
Urology, 2012Co-Authors: Vinod E Nambudiri, Mary Beth Landrum, Elizabeth B Lamont, Barbara J Mcneil, Samuel R Bozeman, Stephen J Freedland, Nancy L KeatingAbstract:Objective To examine the variation in prostate cancer treatment in the Veterans Health Administration (VHA)—a national, integrated delivery system. We also compared the care for older men in the VHA with that in Fee-for-Service Medicare. Methods We used data from the Veterans Affairs Central Cancer Registry linked with administrative data and Surveillance, Epidemiology, and End Results-Medicare data to identify men with local or regional prostate cancer diagnosed during 2001 to 2004. We used multinomial logistic and hierarchical regression models to examine the patient, tumor, and facility characteristics associated with treatment in the VHA and, among older patients, used propensity score methods to compare primary therapy between the VHA and Fee-for-Service Medicare. Results The rates of radical prostatectomy and radiotherapy varied substantially across VHA facilities. Among the VHA patients, older age, black race/ethnicity, and greater comorbidity were associated with receiving neither radical prostatectomy nor radiotherapy. Facilities with more black patients with prostate cancer had lower rates of radical prostatectomy, and those with less availability of external beam radiotherapy had lower radiotherapy rates. The adjusted rates of radiotherapy (39.7% vs 52.0%) and radical prostatectomy (12.1% vs 15.8%) were lower and the rates of receiving neither treatment greater (48.2% vs 32.2%) in the VHA versus Fee-for-Service Medicare ( P Conclusions In the VHA, the treatment rates varied substantially across facilities, and black men received less aggressive prostate cancer treatment than white men, suggesting factors other than patient preferences influence the treatment decisions. Also, primary prostate cancer therapy for older men is less aggressive in the VHA than in Fee-for-Service Medicare.
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quality of care for older patients with cancer in the veterans health administration versus the private sector a cohort study
Annals of Internal Medicine, 2011Co-Authors: Nancy L Keating, Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Steven H Krasnow, Lawrence N Shulman, Jennifer R Brown, Craig C Earle, Michael S Rabin, Barbara J McneilAbstract:BACKGROUND The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. Studies suggest that the VHA provides better preventive care and care for some chronic illnesses than does the private sector. OBJECTIVE To assess the quality of cancer care for older patients provided by the VHA versus Fee-for-Service Medicare. DESIGN Observational study of patients with cancer that was diagnosed between 2001 and 2004 who were followed through 2005. SETTING VHA and non-VHA hospitals and office-based practices. PATIENTS Men older than 65 years with incident colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. MEASUREMENTS Rates of processes of care for colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. Rates were adjusted by using propensity score weighting. RESULTS Compared with the Fee-for-Service Medicare population, the VHA population received diagnoses of colon (P < 0.001) and rectal (P = 0.007) cancer at earlier stages and had higher adjusted rates of curative surgery for colon cancer (92.7% vs. 90.5%; P < 0.010), standard chemotherapy for diffuse large B-cell non-Hodgkin lymphoma (71.1% vs. 59.3%; P < 0.001), and bisphosphonate therapy for multiple myeloma (62.1% vs. 50.4%; P < 0.001). The VHA population had lower adjusted rates of 3-dimensional conformal or intensity-modulated radiation therapy for prostate cancer treated with external-beam radiation therapy (61.6% vs. 86.0%; P < 0.001). Adjusted rates were similar for 9 other measures. Sensitivity analyses suggest that if patients with cancer in the VHA system have more severe comorbid illness than other patients, rates for most indicators would be higher in the VHA population than in the Fee-for-Service Medicare population. LIMITATION This study included only older men and did not include information about performance status, severity of comorbid illness, or patient preferences. CONCLUSION Care for older men with cancer in the VHA system was generally similar to or better than care for Fee-for-Service Medicare beneficiaries, although adoption of some expensive new technologies may be delayed in the VHA system. PRIMARY FUNDING SOURCE Department of Veterans Affairs.
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end of life care for older cancer patients in the veterans health administration versus the private sector
Cancer, 2010Co-Authors: Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Nancy L Keating, Craig C Earle, Barbara J McneilAbstract:BACKGROUND: Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under Fee-for-Service Medicare arrangements. METHODS: Using propensity score methods, we matched 2913 male veterans who were diagnosed with stage IV lung or colorectal cancer in 2001-2002 and died before 2006 with 2913 similar men enrolled in Fee-for-Service Medicare living in Surveillance, Epidemiology, and End Result (SEER) areas. We assessed chemotherapy within 14 days of death, intensive care unit (ICU) admissions within 30 days of death, and >1 emergency room visit within 30 days of death. RESULTS: Among matched cohorts, men treated in the VHA were less likely than men in the private sector to receive chemotherapy within 14 days of death (4.6% vs 7.5%, P 1 emergency room visit within 30 days of death (13.1 vs 14.7, P = .09). CONCLUSIONS: Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in Fee-for-Service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes. Cancer 2010. © 2010 American Cancer Society.
Barbara J Mcneil - One of the best experts on this subject based on the ideXlab platform.
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understanding variation in primary prostate cancer treatment within the veterans health administration
Urology, 2012Co-Authors: Vinod E Nambudiri, Mary Beth Landrum, Elizabeth B Lamont, Barbara J Mcneil, Samuel R Bozeman, Stephen J Freedland, Nancy L KeatingAbstract:Objective To examine the variation in prostate cancer treatment in the Veterans Health Administration (VHA)—a national, integrated delivery system. We also compared the care for older men in the VHA with that in Fee-for-Service Medicare. Methods We used data from the Veterans Affairs Central Cancer Registry linked with administrative data and Surveillance, Epidemiology, and End Results-Medicare data to identify men with local or regional prostate cancer diagnosed during 2001 to 2004. We used multinomial logistic and hierarchical regression models to examine the patient, tumor, and facility characteristics associated with treatment in the VHA and, among older patients, used propensity score methods to compare primary therapy between the VHA and Fee-for-Service Medicare. Results The rates of radical prostatectomy and radiotherapy varied substantially across VHA facilities. Among the VHA patients, older age, black race/ethnicity, and greater comorbidity were associated with receiving neither radical prostatectomy nor radiotherapy. Facilities with more black patients with prostate cancer had lower rates of radical prostatectomy, and those with less availability of external beam radiotherapy had lower radiotherapy rates. The adjusted rates of radiotherapy (39.7% vs 52.0%) and radical prostatectomy (12.1% vs 15.8%) were lower and the rates of receiving neither treatment greater (48.2% vs 32.2%) in the VHA versus Fee-for-Service Medicare ( P Conclusions In the VHA, the treatment rates varied substantially across facilities, and black men received less aggressive prostate cancer treatment than white men, suggesting factors other than patient preferences influence the treatment decisions. Also, primary prostate cancer therapy for older men is less aggressive in the VHA than in Fee-for-Service Medicare.
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quality of care for older patients with cancer in the veterans health administration versus the private sector a cohort study
Annals of Internal Medicine, 2011Co-Authors: Nancy L Keating, Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Steven H Krasnow, Lawrence N Shulman, Jennifer R Brown, Craig C Earle, Michael S Rabin, Barbara J McneilAbstract:BACKGROUND The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. Studies suggest that the VHA provides better preventive care and care for some chronic illnesses than does the private sector. OBJECTIVE To assess the quality of cancer care for older patients provided by the VHA versus Fee-for-Service Medicare. DESIGN Observational study of patients with cancer that was diagnosed between 2001 and 2004 who were followed through 2005. SETTING VHA and non-VHA hospitals and office-based practices. PATIENTS Men older than 65 years with incident colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. MEASUREMENTS Rates of processes of care for colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. Rates were adjusted by using propensity score weighting. RESULTS Compared with the Fee-for-Service Medicare population, the VHA population received diagnoses of colon (P < 0.001) and rectal (P = 0.007) cancer at earlier stages and had higher adjusted rates of curative surgery for colon cancer (92.7% vs. 90.5%; P < 0.010), standard chemotherapy for diffuse large B-cell non-Hodgkin lymphoma (71.1% vs. 59.3%; P < 0.001), and bisphosphonate therapy for multiple myeloma (62.1% vs. 50.4%; P < 0.001). The VHA population had lower adjusted rates of 3-dimensional conformal or intensity-modulated radiation therapy for prostate cancer treated with external-beam radiation therapy (61.6% vs. 86.0%; P < 0.001). Adjusted rates were similar for 9 other measures. Sensitivity analyses suggest that if patients with cancer in the VHA system have more severe comorbid illness than other patients, rates for most indicators would be higher in the VHA population than in the Fee-for-Service Medicare population. LIMITATION This study included only older men and did not include information about performance status, severity of comorbid illness, or patient preferences. CONCLUSION Care for older men with cancer in the VHA system was generally similar to or better than care for Fee-for-Service Medicare beneficiaries, although adoption of some expensive new technologies may be delayed in the VHA system. PRIMARY FUNDING SOURCE Department of Veterans Affairs.
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end of life care for older cancer patients in the veterans health administration versus the private sector
Cancer, 2010Co-Authors: Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Nancy L Keating, Craig C Earle, Barbara J McneilAbstract:BACKGROUND: Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under Fee-for-Service Medicare arrangements. METHODS: Using propensity score methods, we matched 2913 male veterans who were diagnosed with stage IV lung or colorectal cancer in 2001-2002 and died before 2006 with 2913 similar men enrolled in Fee-for-Service Medicare living in Surveillance, Epidemiology, and End Result (SEER) areas. We assessed chemotherapy within 14 days of death, intensive care unit (ICU) admissions within 30 days of death, and >1 emergency room visit within 30 days of death. RESULTS: Among matched cohorts, men treated in the VHA were less likely than men in the private sector to receive chemotherapy within 14 days of death (4.6% vs 7.5%, P 1 emergency room visit within 30 days of death (13.1 vs 14.7, P = .09). CONCLUSIONS: Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in Fee-for-Service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes. Cancer 2010. © 2010 American Cancer Society.
Andrew B Bindman - One of the best experts on this subject based on the ideXlab platform.
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changes in health care costs and mortality associated with transitional care management services after a discharge among medicare beneficiaries
JAMA Internal Medicine, 2018Co-Authors: Andrew B BindmanAbstract:Importance Medicare adopted transitional care management (TCM) payment codes in 2013 to encourage clinicians to furnish TCM services after beneficiaries were discharged to the community from medical facilities. To bill for the 30-day service, a care team member must communicate with the beneficiary or the caregiver within 2 business days after the discharge and the clinician must provide an office visit within 14 days. Objective To investigate whether the receipt of TCM services was associated with the subsequent health care costs and mortality of the beneficiaries in the month after the service was provided. Design, Setting, and Participants Retrospective cohort analysis of all Medicare Fee-for-Service claims for the period of January 1, 2013, through December 31, 2015, for 18 756 707 Medicare Fee-for-Service beneficiaries with discharges eligible for subsequent TCM services. Discharges from a hospital, an inpatient psychiatric facility, a long-term care hospital, a skilled nursing facility, an inpatient rehabilitation facility, or an outpatient facility for an observational stay were included. Data analysis was performed from July 2016 to March 2018. Exposure Furnishing of TCM services for the 30 days following an eligible discharge for Medicare beneficiaries as reflected in Medicare Fee-for-Service claims. Main Outcomes and Measures Total Medicare (Parts A, B, and D) health care costs and mortality in the 31 to 60 days after discharge, which is 30 days beyond the potential period for which the beneficiary could receive TCM services. Health care costs and mortality were adjusted for beneficiary age, sex, risk score, dual eligibility for Medicare and Medicaid, type of eligible discharge, year of discharge, and whether the eligible discharge to the community included home health care. Results Of 18 756 707 eligible Medicare beneficiaries during the study period, 43.9% were male and had a mean (SD) age of 72.5 (13.8) years. Transitional care management services were billed following eligible discharges in 3.1% of cases in 2013, 5.5% in 2014, and 7.0% in 2015. The adjusted total Medicare costs ($3358; 95% CI, $3324-$3392 vs $3033; 95% CI, $3001-$3065;P Conclusions and Relevance Despite the apparent benefits of TCM services for Medicare beneficiaries, the use of this service remains low. An assessment should be made of interventions that can increase the appropriate use of this service.
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specialists and primary care physicians participation in medicaid managed care
Journal of General Internal Medicine, 2001Co-Authors: Lisa I Backus, Dennis Osmond, Kevin Grumbach, Karen Vranizan, Lucy Phuong, Andrew B BindmanAbstract:OBJECTIVE: To compare specialist and primary care physician participation in California’s Medicaid Fee-for-Service and managed care programs.
Mary Beth Landrum - One of the best experts on this subject based on the ideXlab platform.
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abstract 224 recent trends in coronary artery disease quality performance and implications for clinical practice in the era of alternative payment models
Circulation-cardiovascular Quality and Outcomes, 2019Co-Authors: Lauren G Gilstrap, Micah Aaron, Robert C Wild, Nancy Dean Beaulieu, Michael E Chernew, Mary Beth LandrumAbstract:Background: In light of recent shifts away from Fee-for-Service and toward alternative payment models (APM), national trends in quality performance for common cardiac conditions, such as CAD, are i...
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understanding variation in primary prostate cancer treatment within the veterans health administration
Urology, 2012Co-Authors: Vinod E Nambudiri, Mary Beth Landrum, Elizabeth B Lamont, Barbara J Mcneil, Samuel R Bozeman, Stephen J Freedland, Nancy L KeatingAbstract:Objective To examine the variation in prostate cancer treatment in the Veterans Health Administration (VHA)—a national, integrated delivery system. We also compared the care for older men in the VHA with that in Fee-for-Service Medicare. Methods We used data from the Veterans Affairs Central Cancer Registry linked with administrative data and Surveillance, Epidemiology, and End Results-Medicare data to identify men with local or regional prostate cancer diagnosed during 2001 to 2004. We used multinomial logistic and hierarchical regression models to examine the patient, tumor, and facility characteristics associated with treatment in the VHA and, among older patients, used propensity score methods to compare primary therapy between the VHA and Fee-for-Service Medicare. Results The rates of radical prostatectomy and radiotherapy varied substantially across VHA facilities. Among the VHA patients, older age, black race/ethnicity, and greater comorbidity were associated with receiving neither radical prostatectomy nor radiotherapy. Facilities with more black patients with prostate cancer had lower rates of radical prostatectomy, and those with less availability of external beam radiotherapy had lower radiotherapy rates. The adjusted rates of radiotherapy (39.7% vs 52.0%) and radical prostatectomy (12.1% vs 15.8%) were lower and the rates of receiving neither treatment greater (48.2% vs 32.2%) in the VHA versus Fee-for-Service Medicare ( P Conclusions In the VHA, the treatment rates varied substantially across facilities, and black men received less aggressive prostate cancer treatment than white men, suggesting factors other than patient preferences influence the treatment decisions. Also, primary prostate cancer therapy for older men is less aggressive in the VHA than in Fee-for-Service Medicare.
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quality of care for older patients with cancer in the veterans health administration versus the private sector a cohort study
Annals of Internal Medicine, 2011Co-Authors: Nancy L Keating, Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Steven H Krasnow, Lawrence N Shulman, Jennifer R Brown, Craig C Earle, Michael S Rabin, Barbara J McneilAbstract:BACKGROUND The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. Studies suggest that the VHA provides better preventive care and care for some chronic illnesses than does the private sector. OBJECTIVE To assess the quality of cancer care for older patients provided by the VHA versus Fee-for-Service Medicare. DESIGN Observational study of patients with cancer that was diagnosed between 2001 and 2004 who were followed through 2005. SETTING VHA and non-VHA hospitals and office-based practices. PATIENTS Men older than 65 years with incident colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. MEASUREMENTS Rates of processes of care for colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. Rates were adjusted by using propensity score weighting. RESULTS Compared with the Fee-for-Service Medicare population, the VHA population received diagnoses of colon (P < 0.001) and rectal (P = 0.007) cancer at earlier stages and had higher adjusted rates of curative surgery for colon cancer (92.7% vs. 90.5%; P < 0.010), standard chemotherapy for diffuse large B-cell non-Hodgkin lymphoma (71.1% vs. 59.3%; P < 0.001), and bisphosphonate therapy for multiple myeloma (62.1% vs. 50.4%; P < 0.001). The VHA population had lower adjusted rates of 3-dimensional conformal or intensity-modulated radiation therapy for prostate cancer treated with external-beam radiation therapy (61.6% vs. 86.0%; P < 0.001). Adjusted rates were similar for 9 other measures. Sensitivity analyses suggest that if patients with cancer in the VHA system have more severe comorbid illness than other patients, rates for most indicators would be higher in the VHA population than in the Fee-for-Service Medicare population. LIMITATION This study included only older men and did not include information about performance status, severity of comorbid illness, or patient preferences. CONCLUSION Care for older men with cancer in the VHA system was generally similar to or better than care for Fee-for-Service Medicare beneficiaries, although adoption of some expensive new technologies may be delayed in the VHA system. PRIMARY FUNDING SOURCE Department of Veterans Affairs.
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end of life care for older cancer patients in the veterans health administration versus the private sector
Cancer, 2010Co-Authors: Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Nancy L Keating, Craig C Earle, Barbara J McneilAbstract:BACKGROUND: Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under Fee-for-Service Medicare arrangements. METHODS: Using propensity score methods, we matched 2913 male veterans who were diagnosed with stage IV lung or colorectal cancer in 2001-2002 and died before 2006 with 2913 similar men enrolled in Fee-for-Service Medicare living in Surveillance, Epidemiology, and End Result (SEER) areas. We assessed chemotherapy within 14 days of death, intensive care unit (ICU) admissions within 30 days of death, and >1 emergency room visit within 30 days of death. RESULTS: Among matched cohorts, men treated in the VHA were less likely than men in the private sector to receive chemotherapy within 14 days of death (4.6% vs 7.5%, P 1 emergency room visit within 30 days of death (13.1 vs 14.7, P = .09). CONCLUSIONS: Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in Fee-for-Service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes. Cancer 2010. © 2010 American Cancer Society.
Samuel R Bozeman - One of the best experts on this subject based on the ideXlab platform.
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understanding variation in primary prostate cancer treatment within the veterans health administration
Urology, 2012Co-Authors: Vinod E Nambudiri, Mary Beth Landrum, Elizabeth B Lamont, Barbara J Mcneil, Samuel R Bozeman, Stephen J Freedland, Nancy L KeatingAbstract:Objective To examine the variation in prostate cancer treatment in the Veterans Health Administration (VHA)—a national, integrated delivery system. We also compared the care for older men in the VHA with that in Fee-for-Service Medicare. Methods We used data from the Veterans Affairs Central Cancer Registry linked with administrative data and Surveillance, Epidemiology, and End Results-Medicare data to identify men with local or regional prostate cancer diagnosed during 2001 to 2004. We used multinomial logistic and hierarchical regression models to examine the patient, tumor, and facility characteristics associated with treatment in the VHA and, among older patients, used propensity score methods to compare primary therapy between the VHA and Fee-for-Service Medicare. Results The rates of radical prostatectomy and radiotherapy varied substantially across VHA facilities. Among the VHA patients, older age, black race/ethnicity, and greater comorbidity were associated with receiving neither radical prostatectomy nor radiotherapy. Facilities with more black patients with prostate cancer had lower rates of radical prostatectomy, and those with less availability of external beam radiotherapy had lower radiotherapy rates. The adjusted rates of radiotherapy (39.7% vs 52.0%) and radical prostatectomy (12.1% vs 15.8%) were lower and the rates of receiving neither treatment greater (48.2% vs 32.2%) in the VHA versus Fee-for-Service Medicare ( P Conclusions In the VHA, the treatment rates varied substantially across facilities, and black men received less aggressive prostate cancer treatment than white men, suggesting factors other than patient preferences influence the treatment decisions. Also, primary prostate cancer therapy for older men is less aggressive in the VHA than in Fee-for-Service Medicare.
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quality of care for older patients with cancer in the veterans health administration versus the private sector a cohort study
Annals of Internal Medicine, 2011Co-Authors: Nancy L Keating, Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Steven H Krasnow, Lawrence N Shulman, Jennifer R Brown, Craig C Earle, Michael S Rabin, Barbara J McneilAbstract:BACKGROUND The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. Studies suggest that the VHA provides better preventive care and care for some chronic illnesses than does the private sector. OBJECTIVE To assess the quality of cancer care for older patients provided by the VHA versus Fee-for-Service Medicare. DESIGN Observational study of patients with cancer that was diagnosed between 2001 and 2004 who were followed through 2005. SETTING VHA and non-VHA hospitals and office-based practices. PATIENTS Men older than 65 years with incident colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. MEASUREMENTS Rates of processes of care for colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. Rates were adjusted by using propensity score weighting. RESULTS Compared with the Fee-for-Service Medicare population, the VHA population received diagnoses of colon (P < 0.001) and rectal (P = 0.007) cancer at earlier stages and had higher adjusted rates of curative surgery for colon cancer (92.7% vs. 90.5%; P < 0.010), standard chemotherapy for diffuse large B-cell non-Hodgkin lymphoma (71.1% vs. 59.3%; P < 0.001), and bisphosphonate therapy for multiple myeloma (62.1% vs. 50.4%; P < 0.001). The VHA population had lower adjusted rates of 3-dimensional conformal or intensity-modulated radiation therapy for prostate cancer treated with external-beam radiation therapy (61.6% vs. 86.0%; P < 0.001). Adjusted rates were similar for 9 other measures. Sensitivity analyses suggest that if patients with cancer in the VHA system have more severe comorbid illness than other patients, rates for most indicators would be higher in the VHA population than in the Fee-for-Service Medicare population. LIMITATION This study included only older men and did not include information about performance status, severity of comorbid illness, or patient preferences. CONCLUSION Care for older men with cancer in the VHA system was generally similar to or better than care for Fee-for-Service Medicare beneficiaries, although adoption of some expensive new technologies may be delayed in the VHA system. PRIMARY FUNDING SOURCE Department of Veterans Affairs.
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end of life care for older cancer patients in the veterans health administration versus the private sector
Cancer, 2010Co-Authors: Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Nancy L Keating, Craig C Earle, Barbara J McneilAbstract:BACKGROUND: Treatment of older cancer patients at the end of life has become increasingly aggressive, despite the absence of evidence for better outcomes. We compared aggressiveness of end-of-life care of older metastatic cancer patients treated in the Veterans Health Administration (VHA) and those under Fee-for-Service Medicare arrangements. METHODS: Using propensity score methods, we matched 2913 male veterans who were diagnosed with stage IV lung or colorectal cancer in 2001-2002 and died before 2006 with 2913 similar men enrolled in Fee-for-Service Medicare living in Surveillance, Epidemiology, and End Result (SEER) areas. We assessed chemotherapy within 14 days of death, intensive care unit (ICU) admissions within 30 days of death, and >1 emergency room visit within 30 days of death. RESULTS: Among matched cohorts, men treated in the VHA were less likely than men in the private sector to receive chemotherapy within 14 days of death (4.6% vs 7.5%, P 1 emergency room visit within 30 days of death (13.1 vs 14.7, P = .09). CONCLUSIONS: Older men with metastatic lung or colorectal cancer treated in the VHA healthcare system received less aggressive end-of-life care than similar men in Fee-for-Service Medicare. This may result from the absence of financial incentives for more intensive care in the VHA or because this integrated delivery system is better structured to limit potentially overly aggressive care. Additional studies are needed to assess whether men undergoing less aggressive end-of-life care also experience better outcomes. Cancer 2010. © 2010 American Cancer Society.
