Cancer care up to par at veterans' hospitals: MedlinePlus

Cancer care up to par at veterans' hospitals


URL of this page: http://www.nlm.nih.gov/medlineplus/news/fullstory_112893.html(*this news item will not be available after 09/04/2011)

Monday, June 6, 2011
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By Genevra Pittman

NEW YORK (Reuters Health) - Older men who are diagnosed with cancer and treated at Veterans Health Administration hospitals get care that rivals or beats care given to men covered by Medicare and treated at non-VHA hospitals, according to a new study.

The findings highlight the attention to preventive care and good coordination and integration within the VHA, the researchers write in Annals of Internal Medicine.

They also say the VHA system -- the largest in the U.S., covering some 6.1 million vets -- might serve as "a model for care delivery" as the nation seeks to implement health care reform in a way that provides the best care and the best value.

"The VA has done a really nice job," said lead author Dr. Nancy Keating, from Harvard Medical School. Because the organization works on a budget, "they have to prioritize the care that they deliver," she told Reuters Health.

The finding, she said, "is good news for the (Veterans Administration) and good news for people that are worried both about government running health care and the idea of global budgets" related to health care reform.

Once renowned for its dysfunction, the VHA underwent a major overhaul starting in the 1990s.

Focusing on the period 2001 to 2004, Keating and her colleagues looked at how early cancers were diagnosed and how they were treated in men older than 65 who got care at VHA hospitals compared to men treated in the private sector under fee-for-service Medicare insurance. Their analysis included cases of colorectal cancer, prostate cancer and lung cancer, as well as cancers of the white blood cells (lymphoma) and bone marrow cells (multiple myeloma).

On average, men who got care through the VHA were diagnosed with earlier stages of colorectal cancer than Medicare recipients - possibly suggesting better screening practices, the authors noted. For example, about 29 percent of VHA patients with colon cancer were diagnosed with stage I cancer, the least advanced stage, compared to 24 percent of the Medicare group.

VHA cancer patients were also slightly more likely to get surgery to cure colon cancer, and to get the recommended treatments for lymphoma and multiple myeloma.

Those on Medicare, however, were 40 percent more likely to get new treatments for prostate cancer - which may reflect slower movement by the VHA to adopt new technology compared to the private sector, the authors say.

Patients in both groups got recommended treatments for lung cancer and rectal cancer at similar rates.

"In many ways (the finding) is not surprising," Keating said. With regard to fee-for-service Medicare, "there are lots of problems in a system where there's no accountability, there's no coordination of care," she said.

Part of the VHA's superiority in coordination comes from the use of electronic medical records and a computer system designed to prevent errors, said Phillip Longman, author of Best Care Anywhere: Why VA Health Care is Better Than Yours, who was not involved in the new research.

In addition, the VHA "has a unique relationship with its patients," Longman told Reuters Health. "It starts typically when they leave the military as still pretty young people and extends all the way to nursing home care. As an institution, it has incentives to keep people well, which are lacking elsewhere."

Those incentives lead to better preventive care, Longman, of the New America Foundation in Washington, D.C., said. For example, people in the VHA system all have a primary care doctor, as well as a nurse, social worker, and clerk assigned to them, who work as a team, he noted.

The current study was funded by the Department of Veterans Affairs, and members of the VHA approved the findings and the final paper.

Longman agreed with the authors that the VHA could be a model for national health care reform - saving taxpayers money while providing better care. "Under enlightened management, you can get really innovative, safe, effective models of care that you can't find elsewhere," he said.

SOURCE: http://bit.ly/atTzv0 Annals of Internal Medicine, online June 6, 2011.

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