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Healthcare Utilization Patterns of California Veterans with Colon Cancer – VA Patients Rely on Medicare

Hynes DM, Perrin RA, Zhang Q, Koelling K, Tarlov E, Ferreira MR, Lee TA, Bennett CL. Healthcare Utilization Patterns of California Veterans with Colon Cancer – VA Patients Rely on Medicare. Poster session presented at: AcademyHealth Annual Research Meeting; 2006 Jun 25; Seattle, WA.

Related HSR&D Project(s)


Research Objective: To assess and compare colon cancer care across Veterans Administration and Medicare systems of healthcare Study Design: Based on a quality of care theoretical model, this study links clinical data from the California Cancer Registry with VA and Medicare workload and claims data for a retrospective cohort of colon cancer patients to characterize and compare healthcare use in terms of patient demographics, clinical characteristics and provider choice (VA or Medicare) for surgery and adjuvant chemotherapy. Healthcare use in 1999 through 2003 was examined. Population Studied: A retrospective cohort of incident colon cancer patients, identified from California Cancer Registry data, who were at least 66 years old and eligible to use both VA and Medicare healthcare between 1999 and 2001. Principal Findings: The California Cancer Registry matched cancer cases in their database with a list of potential subjects qualified by age and VA and Medicare eligibility. Selecting only colon cancer cases (ICD-O-3 = 18.0 – 18.9) diagnosed in 1999 – 2001 and eliminating Medicare HMO participants, for whom we have incomplete Medicare records, produced our analytic cohort of 976 cases. Of the 976, 93% were male. African Americans composed 16% of the cohort. Surgery was performed on 707 (72%). Of the 707 surgery cases, 544 (77%) had their surgery in the Medicare healthcare system. Most patients who received adjuvant chemotherapy received it in the same healthcare system where they had their surgery. Only 5% of VA surgery patients and 1% of Medicare surgery patients switched to the other system or used both systems for chemotherapy. There was no significant difference in stage at diagnosis or in number of comorbidities in patients selecting VA care versus Medicare. Conclusions: In California, patients eligible for both VA and Medicare rely heavily on Medicare for cancer care. For patients enrolled and actively engaged in VA healthcare, dual system use raises questions of coordination and costs of care. Although California’s cancer registry represents a large, diverse population and reveals much about the treatment of cancer, to increase the generalizability of our knowledge of the quality and coordination of colon cancer care in both VA and Medicare, this study will be expanded to include data from nine additional cancer registries, including the VA Central Cancer Registry. Implications for Policy, Delivery or Practice: As national cancer organizations and policymakers consider ways to improve colon cancer care in Medicare, and with particular interest focused on the quality of colon cancer care in the VA by the Government Performance and Results Act, this study uses well-validated approaches to ascertain healthcare resource use and quality of care in both systems to provide timely and important information about how quality and efficiency of colon cancer care can be improved.

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