Patient characteristics associated with the level of patient‐reported care coordination among male patients with colorectal cancer in the Veterans Affairs health care system

Abstract

Background We sought to determine if patient characteristics, including race/ethnicity, were associated with patient-reported care coordination for colorectal cancer (CRC) patients treated in the Veterans Affairs (VA) healthcare system, with the goal of better understanding potential goals of quality improvement efforts aimed at improving coordination. Methods The nationwide Cancer Care Assessment and Responsive Evaluation (C-CARES) survey involved VA CRC patients diagnosed in 2008 (response rate=63%). The survey included a 4-item scale of patient-reported frequency (never, sometimes, usually, always) of care coordination activities (scale score range=1-4). Among 913 CRC patients providing information on care coordination, demographics, and symptoms, multivariable logistic regression was used to examine odds of patients reporting optimal care coordination. Results VA CRC patients report high levels of care coordination (mean scale score=3.50 (standard deviation=0.61). Eighty-five percent of patients report a high level of coordination, including the 43% reporting optimal/highest-level coordination. There was no difference in the odds of reporting optimal coordination by race/ethnicity. Patients with early-stage disease (OR: 0.60; 95% CI: 0.45-0.81), greater pain (OR: 0.97 for 1-point increase in pain scale; 95% CI: 0.96-0.99) and greater levels of depression (OR 0.97 for 1-point increase in depression scale; 95% CI: 0.96-0.99) were less likely to report optimal coordination. Conclusion CRC patients in the VA report high levels of care coordination. Unlike what has been reported in settings outside the VA, there appears to be no racial/ethnic disparity in reported coordination. However, challenges remain in ensuring coordination of care for patients with less advanced disease and high symptom burden.

Patterns and predictors of colorectal cancer care coordination: A population‐based survey of Australian patients

“…We also identified potentially modifiable system‐related factors affecting the delivery of coordinated care, such as receiving a written plan before the start of treatment and being referred to a dedicated nurse cancer care coordinator. In contrast to prior research findings, care coordination experience was not associated with ethnicity or early‐stage disease . This could be a result of the different measures used to assess care coordination within each study and could also be a reflection of the differences in the health care systems explored in comparison with Australia (eg, the US Veterans Health Administration).…”

“…In contrast to prior research findings, care coordination experience was not associated with ethnicity 9 or early-stage disease. 11 This could be a result of the different measures used to assess care coordination within each study and could also be a reflection of the differences in the health care systems explored in comparison with Australia (eg, the US Veterans Health Administration).…”

“…One study found that racial, language, and ethnic disparities were associated with poor coordination . However, these results are not widespread, with other studies reporting that patients with poor health literacy, early‐stage disease, and a high symptom burden are more likely to have poorly coordinated care.…”

Racial and Ethnic Differences in Satisfaction with Care Coordination Among VA and non-VA Medicare Beneficiaries

“…Some studies have found that Black non-Hispanic VA users report lower levels of patient satisfaction 44 , 45 and are less likely to receive follow-up outpatient care, 27 although studies have found little or no disparity in satisfaction of care or care coordination between White and Black non-Hispanic VA users. 46 , 47 Our finding that there are smaller disparities in satisfaction with dimensions of care coordination among VA users adds to the literature. An important consideration is that Black non-Hispanics are more likely to use the VHA for their sole source of care, 48 , 49 and furthermore, that Black non-Hispanic veterans, as well as Hispanic veterans, report that they preferred the VA to other healthcare systems.…”

Development and psychometric evaluation of a questionnaire to measure cancer patients’ perception of care coordination

“…A growing body of evidence has provided some insights on cancer CC, mostly based on health care systems or providers' perspectives on CC. According to research conducted within closed systems such as the Veterans Administration Health System and Kaiser, patients have generally reported favorable cancer care coordination experiences [10,[12][13][14]. It is possible that positive reports of cancer care coordination experiences in these closed systems are due to limited numbers of providers involved and centralized systems that allow easier access to non-provider based personnel.…”