martes, 13 de marzo de 2012

Cancer patients do well at veterans' hospitals: MedlinePlus

Cancer patients do well at veterans' hospitals: MedlinePlus

Cancer patients do well at veterans' hospitals

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Friday, March 9, 2012Reuters Health Information Logo
By Genevra Pittman
NEW YORK (Reuters Health) - Older men treated for cancer at Veterans Health Administration hospitals do just as well, if not better, than men covered by Medicare, a new study suggests.
That finding is a testament to massive changes in the organization of the VHA started in the mid-1990s that made patient care more coordinated, strengthened preventive care and allowed medical mistakes to be spotted faster, researchers said.
It seems like the VA is doing a good job of taking care of veterans, which is obviously a good story," said Mary Beth Landrum, the study's lead author from Harvard Medical School in Boston.
The finding, she added, “does hint at the fact that this reorganization of health care may really work well" -- and could be a model for health care reform in the United States.
Landrum and her colleagues compared men's chances of surviving a diagnosis of colon or rectal cancer, lung cancer, lymphoma or bone marrow cancer depending on whether they were treated at VHA hospitals or through Medicare, the government insurance program for the elderly, from 2001 through 2004.
All of the men were older than 65, while those treated at the VHA -- which is responsible for some 6.1 million veterans -- were more likely to be African American and from poorer communities.
After accounting for as many differences as they could between the two groups of patients, the researchers found that men treated for colon cancer at the VHA survived an average of four years and one month after their diagnosis, compared to three years and seven months among Medicare patients.
That improved survival seemed largely due to comprehensive screening at the VHA, and earlier diagnoses as a result. Guidelines recommended checking for signs of colon cancer in most adults age 50 to 75 every ten years with colonoscopy, or at shorter intervals if other screening methods are used.
The same pattern held for men with non-small cell lung cancer: those treated at the VA lived an average of eight months post-diagnosis, while those on Medicare survived an average of six months.
There were no differences in survival for rectal cancer, small-cell lung cancer, lymphoma or bone marrow cancer based on how men got their care.
The researchers said they can't be sure that some VHA patients lived longer because they got better treatment, in part because Landrum's team may not have been able to factor in all possible differences between the two groups of men.
It's hard to be definitive about any of this," Landrum told Reuters Health.
Still, she added, “There's really no evidence that outcomes are worse at the VA, and they may in fact be better."
There are lessons to be learned" from the VHA's turnaround, said Dr. Stephen Edge, from the Roswell Park Cancer Institute in Buffalo, New York, who wrote a commentary accompanying the new study in the Journal of Clinical Oncology.
For example, he told Reuters Health, the VHA was the first organization to start widely using electronic medical records, so that the same patient could be treated at a VHA hospital in California one day, and another VHA hospital in New York the next.
The veterans' organization also started a quality improvement program for surgeons to evaluate complications occurring during surgery, Edge added, which is now being used at a national level outside of the VHA.
What achieves quality improvement is setting up a culture of change, a culture of quality, where people are rewarded for bringing up problems and not punished for bringing up problems," he said. An organizational commitment to quality works."
SOURCE: Journal of Clinical Oncology, online March 5, 2012.
Reuters Health
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