Better Care Communication

According to the study’s authors, VA’s success in this area can be attributed to several reasons, almost all dealing with the strengths of being an integrated health-care system. Those include an electronic medical record system, good communication between physicians and a health quality improvement program.

This is what VA has been working toward for the last 20 years, said Michael Kelly, MD, VA’s national program director for oncology.

“The transformation of VA is well known, with the creation of the EHR and a continuing focus on quality and the systems that VA put in place to ensure that measures of quality were looked at,” Kelly said.

Most of VA’s larger facilities have some sort of chemotherapy program on-site, and those which do not partner with facilities that do. About half of VA’s larger facilities have radiation therapy programs, with the others contracting outside of VA.

“We did an analysis [to examine] the utilization of radiation services and found that it didn’t seem to matter whether the patient was in or out of VA, as long as they got the service at the time they needed it,” Kelly said.

Three VA facilities have the ability to perform hematopoietic stem cell transplants — a comparatively rare and complex procedure.

The most significant cancer care improvement has come from VA’s prevention initiatives, Kelly said. Using the EHR, VA can remind physicians to offer and provide regular screening or prevention measures, such as colonoscopies to search for colon cancer or smoking cessation programs to prevent lung cancer.

“The EHR allows VA to have excellent tracking of patients throughout the system, identifying patients that need particular services and making sure they get it,” Kelly said.

VA also has the advantage of a being a single, comprehensive system.  “We don’t have quite the same communication problems between the different specialists. We’re all using the same record systems, and patients can flow relatively easy between specialties,” according to Kelly.

The study authors also note that, unlike in some private-sector systems, VA physicians are not financially rewarded for prescribing more drugs or procedures, resulting in less overtreatment.

It doesn’t hurt, Kelly said, that VA is less expensive for the patient than private-sector systems.

“We remove the financial barriers,” he pointed out. “Cancer treatments are sometimes extremely expensive. My understanding is that, if you provide good or better care and you only cost half as much, that’s a great value.”

The study’s lead author, Nancy Keating, an associate professor of health-care policy at Harvard Medical School, noted in a Harvard article that rates of recommended care were relatively low in both settings for some of the treatments studied.  She suggested that this may be because of a lack of data on the benefits versus risks of these drugs in older patients and recommended that future cancer clinical trials include both older individuals and those with comorbid illnesses.

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