Health Services Research & Development

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2007 HSR&D National Meeting Abstract

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National Meeting 2007

3028 — Variability of Access to Quality Colorectal Cancer Care in the VA Healthcare System

Gellad ZF (Durham VAMC, Duke University Medical Center) , Jackson GL (Durham VAMC, Duke University Medical Center), Khwaja R (Durham VAMC, Duke University Medical Center), Powell AA (Minneapolis VAMC), Paynter B (Durham VAMC), Zafar Y (Durham VAMC, Duke University Medical Center), Garrett MM (Durham VAMC, Duke University Medical Center), Provenzale DT (Durham VAMC, Duke University Medical Center)

Objectives:
Despite advances in screening for colorectal cancer, patients continue to present with late-stage disease. Improving access to quality care is an integral step in reversing this trend. We therefore reviewed the data from a recent Oncology program evaluation conducted by the Department of Veterans Affairs (VA) to determine the variability of access to colorectal cancer care at 21 VA sites (one per VISN) associated with the Colorectal Cancer Care Collaborative (C4).

Methods:
The program review was undertaken in December 2005 by Abt Associates Inc. and Harvard Medical School. One hundred thirty-eight VA medical centers were asked about their service and staffing levels at the time of the survey. We accessed facility-level data from this survey for the 21 VA sites involved in C4. Sites were categorized as low, medium, or high complexity based on VA designations that reflect volume of veterans served, availability of intensive care units, physician staffing levels, patient risk, and levels of teaching and research.

Results:
The survey response rate was 100 percent. There were sixteen high complexity sites, one medium complexity site, and four low complexity sites included in the analysis. Only 42.8 percent of C4 sites had American College of Surgeons Commission on Cancer certification, all of which were high complexity facilities. Fifty percent of low complexity sites lacked a tumor board as compared to 6.3 percent of high complexity sites. All high complexity sites had on-site pathologists available to review specimens during procedures as compared to only 50 percent of low-complexity sites. General surgeons were more likely to be available on-site at high complexity sites (100 percent) as compared to low complexity sites (50 percent). Availability of colorectal surgeons showed a similar pattern (81.3 percent vs. 0 percent).

Implications:
The availability of colorectal cancer care services in the VA healthcare system varies widely. Much of this variability results from facility-level staffing arrangements that limit access to optimal care at lower complexity facilities.

Impacts:
Further investigation of the variability of access to cancer care, especially in regards to its effect on outcome, is imperative. The C4 initiative will allow such an investigation and is ongoing.