Reduced Overall and Event-Free Survival among Colon Cancer Patients Using Dual System Care

Tarlov, Elizabeth; Lee, Todd A.; Weichle, Thomas W.; Durazo‐Arvizu, Ramón; Zhang, Qiuying; Perrin, Ruth; Bentrem, David J.; Hynes, Denise M.

doi:10.1158/1055-9965.epi-12-0548

Cited by 37 publications

(35 citation statements)

References 35 publications

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“…VA facilities generally performed comparably or favorably relative to other settings in terms of mortality. Mortality rates associated with specific conditions [16][17][18][19] or following surgery [20][21][22][23][24][25][26] were often similar for VA patients compared with non-veterans, and occasionally lower. 17 However, some studies found higher surgical mortality among VA patients compared with non-veterans.…”

Section: Safetymentioning

confidence: 99%

Comparing VA and Non-VA Quality of Care: A Systematic Review

et al. 2016

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Section: Safetymentioning

confidence: 99%

Comparing VA and Non-VA Quality of Care: A Systematic Review

et al. 2016

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“…Thus, a second option would be for smaller VA facilities without the full complement of policyrecommended services to partner with local non-VA sites to obtain access to comprehensive thoracic oncology care. However, such referral-based strategies face challenges related to access and coordination of care (32)(33)(34)(35)(36). The optimal solution to provide access to screening to as many eligible patients as possible while maintaining the efficacy and safety seen in the NLST therefore remains unclear.…”

Section: Original Researchmentioning

confidence: 99%

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

et al. 2016

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Rationale: To mitigate the potential harms of screening, professional societies recommend that lung cancer screening be conducted in multidisciplinary programs with the capacity to provide comprehensive care, from screening through pulmonary nodule evaluation to treatment of screen-detected cancers. The degree to which this standard can be met at the national level is unknown.Objectives: To assess the readiness of clinical facilities in a national healthcare system for implementation of comprehensive lung cancer screening programs, as compared with the ideal described in policy recommendations.Methods: This was a cross-sectional, self-administered survey of staff pulmonologists in pulmonary outpatient clinics in Veterans Health Administration facilities. Measurements and Main Results:The facility-level response rate was 84.1% (106 of 126 facilities with pulmonary clinics); 88.7% of facilities showed favorable provider perceptions of the evidence for lung cancer screening, and 73.6% of facilities had a favorable provider-perceived local context for screening implementation. All elements of the policyrecommended infrastructure for comprehensive screening programs were present in 36 of 106 facilities (34.0%); the most common deficiencies were the lack of on-site positron emission tomography scanners or radiation oncology services. Overall, 26.5% of Veterans Health Administration facilities were ideally prepared for lung cancer screening implementation (44.1% if the policy recommendations for on-site positron emission tomography scanners and radiation oncology services were waived).Conclusions: Many facilities may be less than ideally positioned for the implementation of comprehensive lung cancer screening programs. To ensure safe, effective screening, hospitals may need to invest resources or coordinate care with facilities that can offer comprehensive care for screening through downstream evaluation and treatment of screen-detected cancers.

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“…However, our findings add to evidence on the association between dual use measured at the individual level and increased healthcare utilization as well as adverse outcomes. For example, Jia and colleagues observed higher hospital readmission rates and mortality among dual users after stroke, and Tarlov and colleagues observed higher mortality among dual users of colon cancer care 28, 29. More recently, Bolden and colleagues found that dual system care was associated with lower likelihood of wound healing in patients with chronic pressure ulcer 30…”

Section: Discussionmentioning

confidence: 99%

Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

Axon

Gebregziabher

Everett

et al. 2018

JAHA

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BackgroundIndividuals receiving cross‐system care (dual users) have higher rates of healthcare utilization and worse outcomes for heart failure (HF) and other conditions. Individuals can be dual users or single‐system users at different times, though, and little is known about utilization and mortality within discrete episodes of care.Methods and ResultsA retrospective cohort of 3439 patients with 5231 discrete episodes of HF exacerbation were identified between 2007 and 2011. Episodes encompassed the period from 2 weeks before an initial HF emergency department (ED) visit or hospitalization, included any acute care visits within 30 days after initial visit, and ended 30 days after the last acute care visit in the episode chain. All‐cause and HF‐specific ED visits and hospitalization within 30 days of index visit were analyzed using generalized estimating equations with robust variance. Hazard for death within episodes of acute illness was analyzed using Cox proportional hazards models. In adjusted analyses, dual use acute HF episodes were associated with higher odds of all‐cause ED visits (odds ratio 1.61, 95% confidence interval [CI], 1.33, 1.95), HF‐specific ED visits, (odds ratio 1.54, 95% CI, 1.12, 2.13), all‐cause hospitalization (odds ratio 1.89, 95% CI, 1.50, 2.38), and HF‐specific hospitalization (odds ratio 1.62, 95% CI, 1.15–2.30) as compared with Veterans Health Administration–only episodes of acute HF care. Dual use episodes of care were associated with higher hazard for mortality (hazard ratio=1.52, 95% CI 1.07, 2.16) as compared with all–Veterans Health Administration episodes of care.ConclusionsEpisodes of acute HF care spanning across healthcare systems appear to be associated with higher risk of subsequent ED visits, hospitalization, and mortality.

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Reduced Overall and Event-Free Survival among Colon Cancer Patients Using Dual System Care

Cited by 37 publications

References 35 publications

Comparing VA and Non-VA Quality of Care: A Systematic Review

Comparing VA and Non-VA Quality of Care: A Systematic Review

Readiness for Implementation of Lung Cancer Screening: A National Survey of VA Pulmonologists

Dual Healthcare System Use During Episodes of Acute Care Heart Failure Associated With Higher Healthcare Utilization and Mortality Risk

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