Center for Management of Complex Chronic Care, Edward Hines, Jr. VA Hospital, 5000 South 5th Ave., 151H, Hines, IL 60141, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Dec;21(12):2231-41. doi: 10.1158/1055-9965.EPI-12-0548. Epub 2012 Oct 11.
Many veterans have dual Veterans Administration (VA) and Medicare healthcare coverage. We compared 3-year overall and cancer event-free survival (EFS) among patients with nonmetastatic colon cancer who obtained substantial portions of their care in both systems and those whose care was obtained predominantly in the VA or in the Medicare fee-for-service system.
We conducted a retrospective observational cohort study of patients older than 65 years with stages I to III colon cancer diagnosed from 1999 to 2001 in VA and non-VA facilities. Dual use of VA and non-VA colon cancer care was categorized as predominantly VA use, dual use, or predominantly non-VA use. Extended Cox regression models evaluated associations between survival and dual use.
VA and non-VA users (all stages) had reduced hazard of dying compared with dual users [e.g., for stage I, VA HR 0.40, 95% confidence interval (CI): 0.28-0.56; non-VA HR 0.54, 95% CI: 0.38-0.78). For EFS, stage I findings were similar (VA HR 0.47, 95% CI: 0.35-0.62; non-VA HR 0.64, 95% CI: 0.47-0.86). Stage II and III VA users, but not non-VA users, had improved EFS (stage II: VA HR 0.74, 95% CI: 0.56-0.97; non-VA HR 0.92, 95% CI: 0.69-1.22; stage III: VA HR 0.73, 95% CI: 0.56-0.94; non-VA HR 0.81, 95% CI: 0.62-1.06).
Improved survival among VA and non-VA compared with dual users raises questions about coordination of care and unmet needs.
Additional study is needed to understand why these differences exist, why patients use both systems, and how systems may be improved to yield better outcomes in this population.
许多退伍军人同时拥有退伍军人事务部（VA）和医疗保险医疗保健覆盖。我们比较了在 VA 和非 VA 设施中诊断为 1999 年至 2001 年期间患有 I 至 III 期结肠癌且大部分治疗在两个系统中完成以及主要在 VA 或医疗保险按服务收费系统中接受治疗的患者的 3 年总体和癌症无事件生存（EFS）。
我们对在 VA 和非 VA 设施中诊断为 I 至 III 期结肠癌且年龄大于 65 岁的患者进行了回顾性观察队列研究。将 VA 和非 VA 结肠癌护理的双重使用分为主要使用 VA、双重使用或主要使用非 VA。扩展 Cox 回归模型评估了生存与双重使用之间的关联。
VA 和非 VA 用户（所有分期）与双重使用者相比，死亡风险降低[例如，对于 I 期，VA HR 0.40，95%置信区间（CI）：0.28-0.56；非 VA HR 0.54，95% CI：0.38-0.78]。对于 EFS，I 期发现结果相似（VA HR 0.47，95% CI：0.35-0.62；非 VA HR 0.64，95% CI：0.47-0.86）。II 期和 III 期 VA 用户，但非非 VA 用户，EFS 得到改善（II 期：VA HR 0.74，95% CI：0.56-0.97；非 VA HR 0.92，95% CI：0.69-1.22；III 期：VA HR 0.73，95% CI：0.56-0.94；非 VA HR 0.81，95% CI：0.62-1.06）。
与双重使用者相比，VA 和非 VA 的生存改善引发了关于护理协调和未满足需求的问题。
需要进一步研究以了解为什么会存在这些差异，为什么患者同时使用这两个系统，以及如何改进系统以在这一人群中获得更好的结果。
