Center for Clinical Management Research, Health Services Research and Development Service, Veterans Affairs Ann Arbor Healthcare System, Ann Arbor, Michigan; Dow Division of Health Services Research, Department of Urology, University of Michigan, Ann Arbor, Michigan.
Cancer. 2013 Oct 15;119(20):3629-35. doi: 10.1002/cncr.28275. Epub 2013 Jul 30.
Patient travel distances, coupled with variation in facility-level resources, create barriers for prostate cancer care in the Veterans Health Administration integrated delivery system. For these reasons, the authors investigated the degree to which these barriers impact the quality of prostate cancer care.
The Veterans Affairs Central Cancer Registry was used to identify all men who were diagnosed with prostate cancer in 2008. Patient residence was characterized using Rural Urban Commuting Area codes. The authors then examined whether rural residence, compared with urban residence, was associated with less access to cancer-related resources and worse quality of care for 5 prostate cancer quality measures.
Approximately 25% of the 11,368 patients who were diagnosed with prostate cancer in 2008 lived in either a rural area or a large town. Rural patients tended to be white (62% urban vs 86% rural) and married (47% urban vs 63% rural), and they tended to have slightly higher incomes (all P<.01) but similar tumor grade (P=.23) and stage (P=.12) compared with urban patients. Rural patients were significantly less likely to be treated at facilities with comprehensive cancer resources, although they received a similar or better quality of care for 4 of the 5 prostate cancer quality measures. The time to prostate cancer treatment was similar (rural patients vs urban patients, 96.6 days vs 105.7 days).
Rural patients with prostate cancer had less access to comprehensive oncology resources, although they received a similar quality of care, compared with their urban counterparts in the Veterans Health Administration integrated delivery system. A better understanding of the degree to which facility factors contribute to the quality of cancer care may assist other organizations involved in rural health care delivery.
患者的出行距离，加上医疗机构资源的差异，给退伍军人健康管理局（VA）综合医疗体系中的前列腺癌治疗带来了障碍。基于这些原因，作者研究了这些障碍对前列腺癌治疗质量的影响程度。
作者使用退伍军人事务部中央癌症登记处（VA Central Cancer Registry）来确定所有在 2008 年被诊断患有前列腺癌的男性。患者居住地使用城乡通勤区（Rural Urban Commuting Area）代码进行特征描述。然后，作者检查了与城市居住相比，农村居住是否与获得癌症相关资源的机会减少和 5 个前列腺癌质量指标的治疗质量更差有关。
2008 年被诊断患有前列腺癌的 11368 名患者中，约有 25%居住在农村或大城镇。农村患者往往是白人（62%的城市患者和 86%的农村患者）和已婚（47%的城市患者和 63%的农村患者），而且他们的收入略高（所有 P<.01），但肿瘤分级（P=.23）和分期（P=.12）与城市患者相似。尽管农村患者接受的治疗质量与城市患者相似或更好，但他们接受综合癌症资源治疗的可能性显著降低。前列腺癌治疗时间相似（农村患者和城市患者分别为 96.6 天和 105.7 天）。
与 VA 综合医疗体系中的城市患者相比，农村前列腺癌患者获得全面肿瘤学资源的机会较少，但他们接受的治疗质量相似。更好地了解设施因素对癌症治疗质量的影响程度，可能有助于其他参与农村医疗服务的组织。
