Quality of supportive care for patients with advanced lung cancer in the Veterans health administration

Abstract

Background Morbidity related to cancer and its treatment remains a significant source of human suffering and a challenge to the delivery of high-quality care. Objective To develop and apply quality indicators to evaluate quality of supportive care for advanced lung cancer in the Veterans Health Administration (VHA) and examine facility-level predictors of quality. Methods We evaluated supportive care quality using 12 quality indicators. Data were taken from VHA electronic health records for incident lung cancer cases occurring during 2007. Organizational characteristics of 111 VHA facilities were examined for association with receipt of care. Results Rates of care-receipt were high, especially in the treatment toxicity (89%) and pain management (79%-98%) domains, but were lower in the palliative cancer treatment (60%-90%) and hospice (75%) domains, with substantial facility-level variation. Presence of a care tracking method that was monitored by a midlevel practitioner seemed to be associated with better quality for treatment toxicity (OR, 3.38; 95% CI, 1.87-6.10) and referral to hospice (OR, 1.60; 95% CI, 1.22-2.28); having a psychologist for cancer patients was associated with higher odds for pain management (OR, 1.76; 95% CI, 1.16-2.66). Limitations Not all supportive care was evaluated. Care processes identifed as present at facilities may not have been applied to cohort patients. Facility-level results may be influenced by errors in attributing a patient's care to the correct facility. Conclusions Quality indicators for supportive cancer care can be developed and applied in large evaluations using electronic health record review. This study confrmed high-quality supportive care, while identifying significant facility-level variation in VHA. Funding Veterans Health Administration Offce of Informatics and Analytics.