Quality of prostate cancer care among rural men in the Veterans Health Administration

Authors

  • Ted A. Skolarus MD, MPH,

    Corresponding author
    1. Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    2. Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan
    • Corresponding author: Ted A. Skolarus, MD, MPH, Department of Urology, University of Michigan, VA Center for Clinical Management Research, VA Ann Arbor Healthcare System, Ann Arbor, MI 48109-5330; Fax: (734) 232-2400; tskolar@med.umich.edu

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  • Stephanie Chan PhD,

    1. Frederick S. Pardee RAND Graduate School, Santa Monica, California
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  • Jeremy B. Shelton MD, MS,

    1. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
    2. Department of Urology, University of California at Los Angeles, Los Angeles, California
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  • Anna Liza Antonio MS,

    1. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
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  • Anne E. Sales RN, PhD,

    1. Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan
    2. School of Nursing, University of Michigan, Ann Arbor, Michigan
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  • Jennifer L. Malin MD,

    1. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
    2. Medical Oncology, Wellpoint Inc., Indianapolis, Indiana
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  • Christopher S. Saigal MD, MPH

    1. Veterans Affairs Greater Los Angeles Healthcare System, Los Angeles, California
    2. Department of Urology, University of California at Los Angeles, Los Angeles, California
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  • This article is US. Government work and, as such, is in the public domain in the United States of America.

Abstract

BACKGROUND

Patient travel distances, coupled with variation in facility-level resources, create barriers for prostate cancer care in the Veterans Health Administration integrated delivery system. For these reasons, the authors investigated the degree to which these barriers impact the quality of prostate cancer care.

METHODS

The Veterans Affairs Central Cancer Registry was used to identify all men who were diagnosed with prostate cancer in 2008. Patient residence was characterized using Rural Urban Commuting Area codes. The authors then examined whether rural residence, compared with urban residence, was associated with less access to cancer-related resources and worse quality of care for 5 prostate cancer quality measures.

RESULTS

Approximately 25% of the 11,368 patients who were diagnosed with prostate cancer in 2008 lived in either a rural area or a large town. Rural patients tended to be white (62% urban vs 86% rural) and married (47% urban vs 63% rural), and they tended to have slightly higher incomes (all P < .01) but similar tumor grade (P = .23) and stage (P = .12) compared with urban patients. Rural patients were significantly less likely to be treated at facilities with comprehensive cancer resources, although they received a similar or better quality of care for 4 of the 5 prostate cancer quality measures. The time to prostate cancer treatment was similar (rural patients vs urban patients, 96.6 days vs 105.7 days).

CONCLUSIONS

Rural patients with prostate cancer had less access to comprehensive oncology resources, although they received a similar quality of care, compared with their urban counterparts in the Veterans Health Administration integrated delivery system. A better understanding of the degree to which facility factors contribute to the quality of cancer care may assist other organizations involved in rural health care delivery. Cancer 2013;119:3629–3635. © 2013 American Cancer Society.

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