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BACKGROUND/RATIONALE:
Only one published study based on secondary data has investigated VA quality of care in breast cancer. This study found that morbidity and readmissions rates for breast cancer patients treated in the VA are similar to those reported in the private sector. However, breast cancer patients in the VA were found to have longer lengths of stay and higher rates of mastectomy rather than breast conserving surgery. Results of this study were limited in several ways. First, the analysis was not adjusted for stage of disease. Second, it did not make direct comparisons between VA and non-VA outcomes. Lastly, it did not include non-surgical outcome measures of quality care for breast cancer. The proposed study will address all of these issues.
OBJECTIVE(S):
The immediate objectives of this multi-year retrospective study are: 1) To determine if the quality of surgical care provided for women with locoregional breast cancer in the VA is comparable to that provided in the private sector; 2) To identify factors within the VA system that are associated with quality of care (process and outcome measures) for locoregional breast cancer; and 3) To provide policy recommendations regarding how to improve the quality of treatment based on the results of this analysis. Ultimately, our long-term goal is to improve patient outcomes for women veterans with breast cancer
METHODS:
This two year retrospective cross sectional study will use secondary data analysis strategies to investigate the quality of care for treatment of locoregional breast cancer in the VA. In doing so, we will combine information from a variety of sources to develop a comprehensive overview of the structure of care, processes of care, and outcomes associated with breast cancer treatment within the conceptual framework of the study. This strategy takes advantage of the rich extant database available (NSQIP, VA and ACS Cancer Registries, VA administrative data, etc.) and allows for efficient (relative to prospective data collection) analyses and reporting of findings. All female patients treated for locoregional breast cancer in the VA (approximately 950) and patients treated in non-VA NSQIP participating hospitals (approximately 9,100) will be included. There will be multiple dependent variables for the analyses including short term surgical morbidity and mortality, the use of breast conserving surgery, and the adherence to established clinical operative guidelines. Bi-variate (chi square and t-tests) and multivariate (regression) analyses will be employed in the analysis.
FINDINGS/RESULTS:
We are working with various sources within and outside of the VA to obtain all of the data needed.
IMPACT:
The VA is committed to providing high quality, accessible, and cost effective care to all veterans. The numbers of patients receiving primary treatment for breast cancer increased in the VA during the 1990s. Information obtained through this study will help determine the quality of treatment for locoregional breast cancer in the VA. Based on the results of this study, recommendations concerning how to maintain/improve quality treatment for breast cancer will be made.
It is difficult to determin how further impact of the study until the data are available.
PUBLICATIONS:
None at this time.
DRA:
Health Services and Systems, Special (Underserved, High Risk) Populations
DRE:
Quality of Care, Treatment
Keywords:
Cancer, Women - or gender differences, Outcomes
MeSH Terms:
none
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