This Article Full Text Full Text (PDF) Online Supplement All Versions of this Article: 200806-890OCv1 179/7/595    most recent Alert me when this article is cited Alert me if a correction is posted Services Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Schultz, E. M. Articles by Gould, M. K. Search for Related Content PubMed PubMed Citation Articles by Schultz, E. M. Articles by Gould, M. K.

Hospital Characteristics Associated with Timeliness of Care in Veterans with Lung Cancer

¹ Center for Primary Care and Outcomes Research, Stanford School of Medicine, Stanford, California; ² Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, Minnesota; ³ Department of Health Research and Policy, Stanford School of Medicine, Stanford, California; ⁴ Department of Medicine, Division of Pulmonary and Critical Care Medicine, Stanford School of Medicine, Stanford, and VA Palo Alto Health Care System, Palo Alto, California; ⁵ South Central VA Health Care Network, Jackson, Mississippi; ⁶ VA Midwest Health Care Network, Minneapolis, Minnesota; ⁷ Office of Quality and Performance, Veterans Health Administration, Washington, DC; and ⁸ Department of Medicine and Department of Health Research and Policy, Stanford School of Medicine, Stanford, and Pulmonary and Critical Care Medicine Section, VA Palo Alto Health Care System, Palo Alto, California

Correspondence and requests for reprints should be addressed to Michael K. Gould, M.D., M.S., VA Palo Alto Health Care System, 3801 Miranda Ave (111P), Palo Alto, CA 94304. E-mail: gould{at}stanford.edu

Rationale: Timeliness is one of six important dimensions of health care quality recognized by the Institute of Medicine.

Objectives: To evaluate timeliness of lung cancer care and identify institutional characteristics associated with timely care within the Veterans Affairs (VA) health care system.

Methods: We used data from a VA nation-wide retrospective chart review and an independent audit of VA cancer programs to examine the association between time to first treatment and potentially explanatory institutional characteristics (e.g., volume of lung cancer patients) for 2,372 veterans diagnosed with lung cancer between 1 January 2002 and 1 September 2005 at 127 VA medical centers. We developed linear mixed effects models to control for clustering of patients within hospitals and we stratified analyses by stage.

Measurements and Main Results: Median time to treatment varied widely between (23 to 182 d) and within facilities. Median time to treatment was 90 days in patients with stage I or II cancer and 52 days in those with more advanced disease (P < 0.0001). Factors associated with shorter times to treatment included a nonacademic setting and the existence of a specialized diagnostic clinic (in patients with limited-stage disease), performing a patient flow analysis (in patients with advanced disease), and leadership beliefs about providing timely care (in both groups). However, institutional characteristics explained less than 1% of the observed variation in treatment times.

Conclusions: Time to lung cancer treatment in U.S. veterans is highly variable. The numerous institutional characteristics we examined explained relatively little of this variability, suggesting that patient, clinician, and/or unmeasured institutional characteristics may be more important determinants of timely care.

Key Words: lung neoplasms • time factors • quality of health care • hospitals • veterans

AT A GLANCE COMMENTARY Scientific Knowledge on the Subject Few studies have examined timeliness of lung cancer care within the U.S. No studies to date have examined whether institutional characteristics (structures and processes of care) are associated with more or less timely care in patients with lung cancer. What This Study Adds to the Field In this large sample of veterans, time to treatment varied widely and was often longer than recommended by recent guidelines. Institutional factors associated with timeliness differed for patients with limited versus more advanced disease. In both groups, leadership beliefs about providing timely care were associated with shorter times to treatment.