Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care

Samuel, Cleo A.; Landrum, Mary Beth; McNeil, Barbara J.; Bozeman, Samuel R.; Williams, Christina D.; Keating, Nancy L.

doi:10.2105/ajph.2014.302079

Cited by 61 publications

(46 citation statements)

References 45 publications

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“…States differ widely in the care provided for disadvantaged patients; upper Midwest states perform the best, and the southern and south central states perform the worst (128). Most cancer care disparities reported in the Veterans Affairs (VA) system result from differences between VA centers (127). Disparities in hospital quality measures reflect primarily differences between minority-serving and other hospitals (65,133).…”

Section: Principle 6 Differences Between and Within Geographic Areasmentioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

388

232

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The annual National Healthcare Quality and Disparities Reports document widespread and persistent racial and ethnic disparities. These disparities result from complex interactions between patient factors related to social disadvantage, clinicians, and organizational and health care system factors. Separate and unequal systems of health care between states, between health care systems, and between clinicians constrain the resources that are available to meet the needs of disadvantaged groups, contribute to unequal outcomes, and reinforce implicit bias. Recent data suggest slow progress in many areas but have documented a few notable successes in eliminating these disparities. To eliminate these disparities, continued progress will require a collective national will to ensure health care equity through expanded health insurance coverage, support for primary care, and public accountability based on progress toward defined, time-limited objectives using evidence-based, sufficiently resourced, multilevel quality improvement strategies that engage patients, clinicians, health care organizations, and communities.

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Section: Principle 6 Differences Between and Within Geographic Areasmentioning

confidence: 99%

Racial and Ethnic Disparities in the Quality of Health Care

Fiscella

Sanders

2016

Annu. Rev. Public Health

388

232

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“…Underutilization of screening in some racial/ethnic groups contributes to disparities in CRC death rates, [11][12][13][14][15][16] particularly for blacks, who have the highest CRC mortality rates in the US. 17,18 These screening disparities may be related to lack of awareness or acceptance, poor patient-physician communication, economic and structural barriers such as lack of health insurance coverage or usual place of medical care.…”

Section: Introductionmentioning

confidence: 99%

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

et al. 2016

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BACKGROUND: Screening outreach programs using population health management principles offer services uniformly to all eligible persons, but racial/ethnic colorectal cancer (CRC) screening patterns in such programs are not well known. OBJECTIVE: To examine the association between race/ ethnicity and the receipt of CRC screening and timely follow-up of positive results before and after implementation of a screening program. DESIGN: Retrospective cohort study of screen-eligible individuals at the Kaiser Permanente Northern California community-based integrated healthcare delivery system (2004)(2005)(2006)(2007)(2008)(2009)(2010)(2011)(2012)(2013). SUBJECTS: A total of 868,934 screen-eligible individuals 51-74 years of age at cohort entry, which included 662,872 persons in the period before program implementation (2004)(2005)(2006), 654,633 during the first 3 years after implementation (2007)(2008)(2009), and 665,268 in the period from 4 to 7 years (2010-2013) after program implementation. INTERVENTION: A comprehensive system-wide longterm effort to increase CRC that included leadership alignment, goal-setting, and quality assurance through a PHM approach, using mailed fecal immunochemical testing (FIT) along with offering screening at office visits. MAIN MEASURES: Differences over time and by race/ ethnicity in up-to-date CRC screening (overall and by test type) and timely follow-up of a positive screen. Race/ ethnicity categories included non-Hispanic white, nonHispanic black, Hispanic/Latino, Asian/Pacific Islander, Native American, and multiple races. KEY RESULTS: From 2004 to 2013, age/sex-adjusted CRC screening rates increased in all groups, including 35.2 to 81.1 % among whites and 35.6 to 78.0 % among blacks. Screening rates among Hispanics (33.1 to 78.3 %) and Native Americans (29.4 to 74.5 %) remained lower than those for whites both before and after program implementation. Blacks, who had slightly higher rates before program implementation (adjusted rate ratio [RR] = 1.04, 99 % CI: 1.02-1.05), had lower rates after program implementation (RR for period from 4 to 7 years = 0.97, 99 % CI: 0.96-0.97). There were also substantial improvements in timely follow-up of positive screening results. CONCLUSIONS: In this screening program using core PHM principles, CRC screening increased markedly in all racial/ethnic groups, but disparities persisted for some groups and developed in others, which correlated with levels of adoption of mailed FIT.

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“…co-morbidity, age), clinical need (e.g., tumor characteristics) and, if available, preferences for care, between racial groups. [13,28,29] This approach recognizes the mediating role of an individual’s SES and SES-related factors, as minorities tend to have lower SES profiles than whites, and such differences can impact care received. Therefore, the IOM’s model does not adjust for SES-related factors, as doing so may reduce or eliminate the estimated independent effect of race on care and give a false picture of the care experience of vulnerable patients.…”

Section: Methodsmentioning

confidence: 99%

“…Studies of patients with lung, prostate, and colorectal cancers have shown black race to be negatively associated with use of other antiemetic drugs. [12,13] Whether this finding extends to NK1s and to other cancers is unknown. Assessing the relationship between race and NK1 use among breast cancer patients is particularly important, as this population frequently receives highly emetogenic chemotherapy.…”

Section: Introductionmentioning

confidence: 99%

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

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Reeder‐Hayes

Basch

et al. 2016

Breast Cancer Res Treat

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Purpose Chemotherapy-induced nausea and vomiting (CINV) is a major concern for cancer patients and, if uncontrolled, can seriously compromise quality of life (QOL) and other treatment outcomes. Because of the expense of antiemetic medications used to prevent CINV (particularly oral medications filled through Medicare Part D), disparities in their use may exist. Methods We used 2006–2012 SEER-Medicare data to evaluate the use of neuroknin-1 receptor antagonists (NK1s), a potent class of antiemetics, among black and white women initiating highly emetogenic chemotherapy for the treatment of early-stage breast cancer. We used modified Poisson regression to assess the relationship between race and (1) any NK1 use, (2) oral NK1 (aprepitant) use, and (3) intravenous NK1 (fosaprepitant) use. We report adjusted risk ratios (aRR) and 95% confidence intervals (CI). Results The study included 1,130 women. We observed racial disparities in use of any NK1 (aRR: 0.68, 95% CI: 0.51–0.91) and in use of oral aprepitant specifically (aRR: 0.54, 95% CI: 0.35–0.83). We did not observe disparities in intravenous fosaprepitant use. After controlling for variables related to socioeconomic status, disparities in NK1 and aprepitant use were reduced but not eliminated. Conclusions We found racial disparities in women’s use of oral NK1s for the prevention of CINV. These disparities may be partly explained by racial differences in socioeconomic status, which may translate into differential ability to afford the medication.

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Racial Disparities in Cancer Care in the Veterans Affairs Health Care System and the Role of Site of Care

Abstract: Disparities in VA cancer care were observed for 7 of 20 measures and were primarily attributable to within-hospital differences.

Cited by 61 publications

References 45 publications

Racial and Ethnic Disparities in the Quality of Health Care

Racial and Ethnic Disparities in the Quality of Health Care

Race/Ethnicity and Adoption of a Population Health Management Approach to Colorectal Cancer Screening in a Community-Based Healthcare System

Investigating racial disparities in use of NK1 receptor antagonists to prevent chemotherapy-induced nausea and vomiting among women with breast cancer

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