Colorectal Cancer Care Outcomes Research and Quality Surveillance Data System
Dawn Provenzale MD MSc
Durham VA Medical Center HSR&D COE
Durham, NC
Funding Period: July 2003 - September 2009

BACKGROUND/RATIONALE:
The QUERI Executive Committee determined that the development of a colorectal cancer (CRC) data and surveillance is system is a fundamentally necessary first step to ensure that veterans CRC victims reap the benefits of best practice in CRC care, including supportive, palliative and end-of life care.This Service Directed Research project corresponds to the second and third steps in the established QUERI process: identify best practices; and define existing practice patterns and outcomes across VA and current variation from best practices.

OBJECTIVE(S):
There are two principal aims: First, to determine how the characteristics and beliefs of cancer patients and providers and the characteristics of systems of organizations delivering cancer care influence treatment and outcomes across the continuum of care from diagnosis to recovery or death. The study will evaluate the extent to which patients experience these positive elements of cancer care with particular emphasis on the reasons for differences by (a) patients’ age, race, ethnicity, cultural and family support and socioeconomic status; (b) types of providers delivering care; and (c) organizational aspects of care. Second, to evaluate the effects of a select group of common and specific processes of care on clinical outcomes. Examples include: (a) evaluating the effectiveness of proven cancer therapies in types of patients who were underrepresented in those trials (e.g., elderly patients and those with significant co-morbidity); (b) evaluating the effectiveness of proven cancer therapies in routine community settings of care; and (c) exploratory assessments of the effectiveness of a limited number of new or established therapies that have not been definitively studied in randomized trials.

METHODS:
The study uses an observational study design. The VA serves as one of 7 PDCRs (primary data collection and research sites) within the national CanCORS consortium (Cancer Care Outcomes Research and Surveillance). Nationwide, the VA expects to identify approximately 1,000 lung and colorectal cancer patients and will collect data about care delivered in the 3 months previous to diagnosis and 15 months following diagnosis. Primary data will be collected from 3 sources: patient surveys, medical records, and surveys of health care providers. These data will be pooled with cancer registry data and publicly available data sets. The main methods of analysis will be: (1) standard methods for estimating the probability of a binary outcomes or a population mean will be used for estimating population parameters with confidence intervals; (2) regression models for estimating the association of one or more patient-level, physician-level, or health care system feature with an outcome of interest. The 14 Veterans Administration medical centers enrolling patients in this study are: Baltimore, Biloxi, Durham, Chicago-Hines, Chicago-Lakeside, Minneapolis, Nashville, NY Harbor Healthcare System, Temple,Tucson, Atlanta, Houston, Indianapolis and Seattle.

FINDINGS/RESULTS:
We have successfully completed the participant baseline and follow-up surveys, and we are nearing completion of the medical records abstractions. We have also surveyed over 2,000 physicians, across five specialties, who have provided care to the participants. To date, over 2,000 eligible patients have been identified, approximately 1,400 have enrolled, 933 have completed baseline interviews, and 646 have completed follow-up interviews. Approximately 1,400 participants will have their medical records abstracted.

IMPACT:
This study will promote the translation of research discoveries and innovations into patient care and systems improvements in order to reduce the incidence, late detection, suffering and mortality from colon, rectal and lung cancers among veterans.

PUBLICATIONS:

Journal Articles

1. Gellad Z, Almirall D, Provenzale D, Fisher D. Time from positive screening fecal occult blood test to colonsocopy and risk of neoplasia. Gastroenterology. 2008; 134(4): A151.
2. Lieberman DA, Weiss DG, Harford WV, Ahnen DJ, Provenzale D, Sontag SJ, Schnell TG, Chejfec G, Campbell DR, Kidao J, Bond JH, Nelson DB, Triadafilopoulos G, Ramirez FC, Collins JF, Johnston TK, McQuaid KR, Garewal H, Sampliner RE, Esquivel R, Robertson D. Five-year colon surveillance after screening colonoscopy. Gastroenterology. 2007; 133(4): 1077-85.
3. Ayanian JZ, Chrischilles EA, Fletcher RH, Fouad MN, Harrington DP, Kahn KL, Kiefe CI, Lipscomb J, Malin JL, Potosky AL, Provenzale DT, Sandler RS, van Ryn M, Wallace RB, Weeks JC, West DW. Understanding cancer treatment and outcomes: the Cancer Care Outcomes Research and Surveillance Consortium. Journal of Clinical Oncology. 2004; 22(15): 2992-6.

DRA: Chronic Diseases, Health Services and Systems
DRE: Technology Development and Assessment
Keywords: Cancer, Practice patterns, Translation
MeSH Terms: none