Travel distance and time to adjuvant chemotherapy in veterans with colorectal cancer.

2020 ◽  
Vol 38 (4_suppl) ◽  
pp. 84-84
Author(s):  
Richard Lewis Martin ◽  
Gretchen C. Edwards ◽  
Lauren R. Samuels ◽  
Christianne L. Roumie
Keyword(s):  
Rural Areas ◽  
Travel Distance ◽  
Veterans Health ◽  
Health Administration ◽  
Quality Cancer Care ◽  
Tennessee Valley ◽  
Distance To Care ◽  
Cancer Network ◽  
Zip Code ◽  
Timely Treatment

84 Background: Patients from rural areas have well described disparities in quality cancer care. We hypothesized that longer travel distance is associated with less chemotherapy acceptance and less timely treatment. Methods: We reviewed 705 electronic medical records of patients with colorectal surgeries from January 1, 2000 to December 31, 2015 at the Veterans Health Administration Tennessee Valley Healthcare System. Two trained abstractors reviewed standard elements (k = 0.79 – 0.92). The study sample included patients with pathological stage high risk II or III CRC and excluded those with metastatic disease or documented National Comprehensive Cancer Network (NCCN) defined medical exclusions from chemotherapy. Primary exposure was distance to care calculated from central zip code of residence to Nashville infusion center. Primary outcomes were receipt of any chemotherapy, and days from surgery to first treatment (truncated at 120 days). We analyzed 2 populations; chemotherapy received and a second sensitivity population who were eligible for, but did not receive, chemotherapy (no documentation of NCCN ineligibility or declined). Results: Of 705 colorectal resections, we excluded 262 for non-cancer, 220 for stage I or low risk stage II, and 46 for NCCN exclusion criteria, yielding 177 cases: 120 colon and 57 rectal. Most patients were male (98%) and white (85%); median age was 64 [Interquartile Range 60, 70]. Distribution by travel distance was 60/177 [33.9%] < 50 miles, 61/177 [34.5%] 50-99 miles, and 56/177 [31.6%] > 100 miles. Of all eligible patients, 123/177 [69.5%] patients received chemotherapy and 54/177 [30.5%] did not receive chemotherapy. Among receivers, median times to treatment were 52 days [40, 61] < 50 miles; 48.5 [40,61] 50-99 miles; and 54 [43,77] > 100 miles, p = 0.3. Patients not receiving chemotherapy varied by distance: 15/60 (25%) < 50 miles; 18/61 (30%) 50-99 miles; 21/56 (38%) > 100 miles, p = 0.3. Including non-receivers, median times to treatment were 58 days [43, 120] < 50 miles; 58.5 [46.5, 120] 50-99 miles; and 80 [48.5, 120] > 100 miles, p = 0.1. Conclusions: Distance to care may influence acceptability of chemotherapy. Understanding patient/provider reasons for omission merits exploration.

Impact of travel distance on timeliness of adjuvant chemotherapy in veterans with colorectal cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19159-e19159
Author(s):  
Richard Lewis Martin ◽  
Gretchen C. Edwards ◽  
Lauren R. Samuels ◽  
Cathy Eng ◽  
Christianne L. Roumie
Keyword(s):  
Colorectal Cancer ◽  
Cancer Care ◽  
Travel Distance ◽  
Stage Ii ◽  
Veterans Health ◽  
Health Administration ◽  
Quality Cancer Care ◽  
Co Morbidity ◽  
Tennessee Valley ◽  
The Impact

e19159 Background: Rural patients have well described disparities in quality cancer care. The VA Budget and Choice Improvement Act (2015) and VA Mission Act (2018) were passed to increase timely access to cancer care for veterans living at greater distances from VA facilities by paying for community oncology care. We sought to evaluate the baseline timeliness of adjuvant colorectal cancer (CRC) chemotherapy among patients living at increased distances from the Veterans Health Administration Tennessee Valley Healthcare System (VHA-TVHS) to determine local metrics for quality improvement initiatives. Methods: We reviewed 1,107 electronic medical records of patients with colorectal surgeries from January 1, 2000 to December 31, 2015 at the VHA-TVHS. We included patients with NCCN eligible pathologic high-risk stage II (T4/perf, R1, < 12LN, LVI) or stage III CRC and excluded those age ≥80, age ≥75 hospitalized in the prior year with a major co-morbidity, and death or hospice within 30 days of surgery. Primary exposure was travel distance from central zip code of patient residence to VHA-TVHS, categorized < 50 miles (N = 64), 55-99 miles (N = 60), and ≥ 100 miles (N = 56) to account for changes in referral patterns. Outcomes were days from surgery to first chemotherapy treatment and achieving a VHA timeliness standard of 56 days. Eligible patients not receiving chemotherapy were capped at 120 days per Commission on Cancer standard. Results: Of 1,107 colorectal resections, we excluded 623 for non-cancer, 212 for stage I or low risk stage II, 47 for metastases, and 45 for age, co-morbidity, death, and hospice, yielding a final cohort of 121 colon and 59 rectal cancer patients. Patients were predominantly male (96%), white (79%), and median age 64 years [Interquartile Range 60, 70]. Median days to chemotherapy were 62.5 days [48.5, 120] for those who lived < 50 miles, 58.5 days[46.5, 120] for distance 50-99 miles, and 84 days [50.5, 120]) for distance ≥ 100 miles. There were only 41%, 48%, and 32% in each distance group meeting the 56-day standard, respectively. Adjusting for known correlates, time to chemotherapy was 10.6 days longer for patients living ≥ 100 miles compared to < 50 miles (p = 0.08). Conclusions: Distance to care may influence timeliness of chemotherapy among southeast regional veterans. Given the observed overall low rate of timely chemotherapy, understanding modifiable health system factors associated with omissions and delays, as well as the impact of recent VA legislation merits further exploration.

Assessment of patient satisfaction, financial, and environmental impacts of teleoncology.

2021 ◽  
Vol 39 (28_suppl) ◽  
pp. 278-278
Author(s):  
Cindy Jiang ◽  
Garth William Strohbehn ◽  
Rachel Dedinsky ◽  
Shelby Raupp ◽  
Brittany Pannecouk ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Rural Areas ◽  
Financial Burden ◽  
Veterans Health ◽  
Health Administration ◽  
Secondary Effects ◽  
Medical Needs ◽  
Care Access ◽  
Strongly Agree

278 Background: There was rapid adoption of teleoncology at Veterans Health Administration (VHA) during the COVID-19 pandemic. One-third of 9 million VHA-enrolled Veterans live in rural areas. While digital solutions can expand capacity, enhance care access, and reduce financial burden, they may also exacerbate rural-urban health disparities. Careful evaluation of patients’ perceptions and policy tradeoffs are necessary to optimize teleoncology post-pandemic. Methods: Patients with ≥1 teleoncology visit with medical, surgical, or radiation oncology between March 2020 and June 2020 identified retrospectively. Validated, Likert-type survey assessing patient satisfaction developed. Follow-up survey conducted on patients with ≥1 teleoncology visit from August 2020 to January 2021. Travel distance, time, cost, and carbon dioxide (CO2) emissions calculated based on zip codes. Results: 100 surveys completed (response rate, 62%). Table with demographics. Patients overall satisfied with teleoncology (83% ‘Agree’ or ‘Strongly Agree’) but felt less satisfied than in-person visits (47% ‘Agree’ or ‘Strongly Agree’). Audiovisual component improved patient perception of involvement in care (two-sided, p = 0.0254), ability to self-manage health/medical needs (p = 0.0167), and comparability to in person visits (p = 0.0223). Follow-up survey demonstrated similar satisfaction. Total travel-related savings: 86,470 miles, 84,374 minutes, $49,720, and 35.5 metric tons of CO2. Conclusions: Veterans are broadly satisfied with teleoncology. Audiovisual capabilities are critical to satisfaction. This is challenging for rural populations with lack of technology access. Patients experienced financial and time savings, and society benefitted from reduced carbon emissions. Continued optimization needed to enhance patient experience and address secondary effects.[Table: see text]

scholarly journals The Regional Distribution of Psychiatric Residency Positions Funded by the Department of Veterans Affairs and Its Relationship to Rural Veteran Populations

2021 ◽  
Author(s):  
Matthew Vincenti ◽  
Anthony Albanese ◽  
Edward Bope ◽  
Bradley V. Watts
Keyword(s):  
Rural Areas ◽  
Psychiatry Residency ◽  
Regional Distribution ◽  
Geographic Location ◽  
Veterans Affairs ◽  
Psychiatric Residency ◽  
Veterans Health ◽  
Department Of Veterans Affairs ◽  
Health Administration ◽  
Rural Patient

Abstract Objective The authors evaluated the distribution of psychiatry residency positions funded by the Department of Veterans Affairs between 2014 and 2020 with respect to geographic location and hospital patient population rurality. Methods The authors collected data on psychiatry residency positions from the Veterans Affairs’ Office of Academic Affiliations Support Center and data on hospital-level patient rurality from the Veterans Health Administration Support Service Center. They examined the chronological and geospatial relationships between the number of residency positions deployed and the size of the rural patient populations served. Results Between 2014 and 2020, the Department of Veterans Affairs has substantially increased the number of rural hospitals hosting psychiatry residency programs, as well as the number of residency positions at those hospitals. However, several geographic regions serve high numbers of rural veterans with few or no psychiatry resident positions. Conclusions While the VA efforts to increase psychiatry residency positions in rural areas have been partially successful, additional progress can be made increasing support for psychiatry trainees at Veterans Affairs hospitals and community-based outpatient clinics that serve large portions of the rural veteran population.

scholarly journals Transforming Virtual Team-Based Learning for Rural Healthcare Staff: What the Pandemic Taught Us

2021 ◽  
Vol 5 (Supplement_1) ◽  
pp. 739-740
Author(s):  
Eve Gottesman ◽  
Helen Fernandez ◽  
Judith Howe
Keyword(s):  
Rural Areas ◽  
Healthcare Providers ◽  
Veterans Health ◽  
Health Administration ◽  
Web Based ◽  
Virtual Training ◽  
Team Members ◽  
Medical Centers ◽  
History Of

Abstract During COVID-19, many training programs pivoted to virtual formats. For the Rural Interdisciplinary Team Training (RITT) Program, funded by the Veterans Health Administration as part of the Geriatric Scholars Program, there were unique challenges. Given a history of successful accredited in-person, team-based workshops for staff at rural and remote clinics, program developers needed to quickly devise a plan for an effective virtual training for team members working separately from each other. Without the ability to provide in-person education and training, rapid pivoting to virtual modalities was essential for ongoing education of those providing care for older adults. Using a web-based platform, team members and expert trainer facilitation, participants engaged in lively discussions and reflection using the chat feature. RITT adapted the curriculum to better meet the needs of busy healthcare providers working during the pandemic, including increased discussion of how COVID affects older Veterans. Three virtual RITT workshops were held between March 2020 and February 2021 with 64 participants from 12 rural clinics and medical centers. Over 90% of participants agreed or strongly agreed that they were satisfied with the virtual workshop, comparable to those participating in the in-person workshop in earlier years. Similar to others, we have found that the ability to flex a curriculum has benefits to both learners and educators and increases the reach of educational opportunities in gerontology and geriatrics. Particularly in rural areas where travel may be challenging, a virtual format may be a desirable long-term solution for the RITT program.

scholarly journals Regional and Rural–Urban Variation in Opioid Prescribing in the Veterans Health Administration

2019 ◽  
Vol 184 (11-12) ◽  
pp. 894-900 ◽  
Author(s):  
Brian C Lund ◽  
Michael E Ohl ◽  
Katherine Hadlandsmyth ◽  
Hilary J Mosher
Keyword(s):  
Rural Areas ◽  
Regional Variation ◽  
Veterans Health Administration ◽  
Veterans Health ◽  
Health Administration ◽  
Opioid Use ◽  
Opioid Prescribing ◽  
Rural And Urban ◽  
Per Capita

Abstract Introduction Opioid prescribing is heterogenous across the US, where 3- to 5-fold variation has been observed across states or other geographical units. Residents of rural areas appear to be at greater risk for opioid misuse, mortality, and high-risk prescribing. The Veterans Health Administration (VHA) provides a unique setting for examining regional and rural–urban differences in opioid prescribing, as a complement and contrast to extant literature. The objective of this study was to characterize regional variation in opioid prescribing across Veterans Health Administration (VHA) and examine differences between rural and urban veterans. Materials and Methods Following IRB approval, this retrospective observational study used national administrative VHA data from 2016 to assess regional variation and rural–urban differences in schedule II opioid prescribing. The primary measure of opioid prescribing volume was morphine milligram equivalents (MME) dispensed per capita. Secondary measures included incidence, prevalence of any use, and prevalence of long-term use. Results Among 4,928,195 patients, national VHA per capita opioid utilization in 2016 was 1,038 MME. Utilization was lowest in the Northeast (894 MME), highest in the West (1,368 MME), and higher among rural (1,306 MME) than urban (988 MME) residents (p &lt; 0.001). Most of the difference between rural and urban veterans (318 MME) was attributable to differences in long-term opioid use (312 MME), with similar rates of short-term use. Conclusion There is substantial regional and rural–urban variation in opioid prescribing in VHA. Rural veterans receive over 30% more opioids than their urban counterparts. Further research is needed to identify and address underlying causes of these differences, which could include access barriers for non-pharmacologic treatments for chronic pain.

Supporting older military veterans in the rural US

2018 ◽  
Vol 19 (4) ◽  
pp. 286-297
Author(s):  
Bret Hicken ◽  
Kimber Parry
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Access To Health Care ◽  
Veterans Health ◽  
Health Administration ◽  
Care Needs ◽  
Content Type ◽  
Access To Health ◽  
The Us

Purpose The purpose of this paper is to provide an overview of rural older veterans in the US and discuss how the US Department of Veterans Affairs (VA) is increasing access to health care for older veterans in rural areas. Design/methodology/approach This is a descriptive paper summarizing population and program data about rural veterans. Findings VA provides a variety of health care services and benefits for older veterans to support health, independence, and quality of life. With the creation of the Veterans Health Administration Office of Rural Health (ORH) in 2006, the needs of rural veterans, who are on average older than urban veterans, are receiving greater attention and support. ORH and VA have implemented several programs to specifically improve access to health care for rural veterans and to improve quality of care for older veterans in rural areas. Originality/value This paper is one of the first to describe how VA is addressing the health care needs of older, rural veterans.

Tools to accurately identify veterans who undergo molecular diagnostic testing.

2013 ◽  
Vol 31 (31_suppl) ◽  
pp. 201-201
Author(s):  
Michael J. Kelley ◽  
Julie Ann Lynch
Keyword(s):  
Administrative Data ◽  
Language Processing ◽  
Diagnostic Testing ◽  
Molecular Data ◽  
Molecular Diagnostic ◽  
Veterans Health ◽  
Health Administration ◽  
Quality Cancer Care ◽  
Diagnosis Codes ◽  
Chart Audits

201 Background: Yearly, 52,000 veterans are diagnosed with cancer. Minorities represent 18.5% (9,651) of these patients. The rapid and explosive growth of molecular diagnostics (MDx) has created challenges for large healthcare systems such as the Veterans Health Administration (VA) to integrate genomic data into the EMR. Yet, this is an important component of high quality cancer care. In 2011, the VA cancer registry (VACCR) began reporting molecular data. This presentation will describe one project to improve integration of genomics into the EMR and the VACCR. Methods: Using ICD diagnosis codes, we identified veterans diagnosed in 2011 with brain, breast, colon, gastrointestinal stromal, lung, and melanoma cancers. Administrative data was obtained to identify MDx testing. These data were then compared to random chart audits. Significant discrepancies between these sources of data prompted collaboration with national and proprietary reference labs (ARUP, LabCorp, Quest, Genomic Health) to obtain the volume of testing by each VAMC. These data were used to conduct targeted chart reviews to identify the location, processes of care, free and structured text information. These data informed the development of natural language processing (NLP) tools to automatically identify patients that underwent testing. Results: Laboratories had the most accurate source of data. Data from ARUP, Quest, and LabCorp identified a significantly higher volume of testing than reported by administrative data. Applying NLP tools to patients diagnosed with breast cancer identified 44 of the 116 tests ordered for the 21-gene risk score tests. Conclusions: Decision support systems are needed to link tumor SNOMED code to diagnostic testing. Until systems are developed, collaborations with reference labs may be an effective method for identifying molecular data. NLP tools may also serve as an adjunct method for capturing MDx tests ordered from smaller labs.

Abstract P163: Racial, Gender and Regional Variation in Rates of Cardiovascular Hospitalization Among 9 Million US Veterans

Circulation ◽  
2017 ◽  
Vol 135 (suppl_1) ◽  
Author(s):  
Nirupama Krishnamurthi ◽  
Mary A Whooley
Keyword(s):  
Geographical Distribution ◽  
Rural Areas ◽  
Population Level ◽  
Healthcare Services ◽  
Veterans Health ◽  
Health Administration ◽  
Health Records ◽  
Race Ethnicity ◽  
The Individual ◽  
Va Hospitals

Introduction: Little is known about population-level trends in rates of cardiovascular hospitalizations among U.S. Veterans. Recent adoption of a centralized Corporate Data Warehouse in the Veterans Health Administration (VHA) provides a new opportunity to evaluate trends in national rates of hospitalization among Veterans. We sought to determine the leading causes of cardiovascular (CV) hospitalization, and to compare national rates of CV hospitalization by age, gender, race, ethnicity, geographical distribution and year, among U.S. Veterans. Methods: We evaluated the electronic health records of all Veterans ≥18 years old that accessed VA healthcare services between January 1 2010 and December 31 2014. Among these 9,066,693 patients, we identified the 5 leading causes of CV hospitalization and compared rates of hospitalization by age, gender, race, ethnicity, geographical distribution and year. Results: The top 5 causes of CV hospitalization in VA hospitals were: chest pain (3.23 per 1,000 Veterans per year), coronary arteriosclerosis in native artery (2.36), congestive heart failure (1.82), atrial fibrillation (1.34) and acute sub-endocardial infarction (0.99). Overall, the rate of Veterans hospitalized for one or more of these CV conditions decreased over time, from 9.9 per 1000 Veterans in 2010 to 8.3 per 1000 Veterans in 2014. The odds of hospitalization due to any of the 5 conditions were higher in men vs. women (OR 1.73, p<0.0001), in urban vs. rural areas (OR 1.15, p<0.0001), and in the Southeast vs. Pacific regions (OR 1.08, p<0.0001). As compared with Whites, odds of CV hospitalization were higher in Blacks (OR 1.34, p<0.0001) but lower in Asians (OR 0.50, p<0.0001). Racial, geographic and temporal differences in rates of hospitalization were also observed for each of the individual CV conditions. Conclusions: Among U.S. Veterans enrolled in the VA healthcare system, there is substantial variation in rates of CV hospitalization by age, gender, race, geographical distribution and year.

scholarly journals ENGAGING RURAL VETERANS’ PERCEPTIONS OF SURVIVORSHIP CARE FOR HEAD AND NECK CANCER

2019 ◽  
Vol 3 (Supplement_1) ◽  
pp. S1022-S1022
Author(s):  
Aaron T Seaman ◽  
Julia Friberg ◽  
Jenna L Adamowicz ◽  
Nicholas Kendell ◽  
Nitin A Pagedar ◽  
...  
Keyword(s):  
Head And Neck Cancer ◽  
Head And Neck ◽  
Cancer Survivorship ◽  
Neck Cancer ◽  
Rural Areas ◽  
Medical Information ◽  
Care Delivery ◽  
Veterans Health ◽  
Survivorship Care ◽  
Health Administration

Abstract The purpose of this study was to investigate 1) rural patients’ perceptions of their own rurality and its effects on experience of head and neck cancer survivorship, and 2) potential barriers and facilitators to survivorship care within an integrated health care delivery system of the Veterans Health Administration (VHA). Data from qualitative interviews with Veterans who have a history of head and neck cancer are presented to understand the complex ways that rurality impacts cancer survivorship. Head and neck cancer survivors must contend with specific challenges resulting from their risk factors and treatment, including access to complex medical follow up, long-term physical and psychological effects of treatment, and tobacco- and alcohol-related comorbidities. While integration within the VHA facilitates coordination of specialty and primary care and the transfer of medical information, the use of community care in rural areas presents coordination challenges, especially for survivors with comorbidities.

scholarly journals Implementation and evaluation of a pharmacist-run mental health treatment clinic via clinical video telehealth

2016 ◽  
Vol 6 (3) ◽  
pp. 159-164 ◽  
Author(s):  
Molly Leach ◽  
Guadalupe Garcia ◽  
Nicole Ganzer
Keyword(s):  
Mental Health ◽  
Rural Areas ◽  
Mental Health Treatment ◽  
Medical Center ◽  
Medication Management ◽  
Health Resources ◽  
Cost Savings ◽  
Veterans Health ◽  
Health Administration ◽  
Potential Cost

Abstract Introduction: The Veterans Health Administration is extending its mental health services to reach those in rural areas who find it difficult to travel to a Veterans Affairs Medical Center (VAMC). This project aimed to outline implementation of a Pharmacy Mental Health Clinical Video Telehealth (MHCVT) clinic for veterans. Secondary endpoints were to assess patient satisfaction with MHCVT, describe the potential benefits of this clinic regarding travel saved, and summarize no-show rates. Methods: Veterans received mental health disease state medication management from a mental health clinical pharmacy specialist via clinical video telehealth (CVT) in place of an in-clinic appointment and were asked to complete a satisfaction survey after the initial CVT appointment. Data collected from all veterans enrolled in the CVT clinic from September 8, 2014, through March 23, 2015 included: patient demographics, service connection percentage, number of CVT visits, travel miles saved, travel reimbursement, no-show rate, and documentation of medication management therapy. Results: As of March 23, 2015, there were 22 veterans enrolled in the MHCVT clinic, of whom, 19 completed their appointments. Of the 48 potential encounters, 7 were considered a no-show (17%). On average veterans saved 34 travel miles per visit with cumulative savings of 1432.6 miles. Of those who were eligible to receive travel reimbursement (n = 13), the medical center potentially saved $674.50 in a 7-month period. Overall clinic satisfaction per survey (n = 14) was 100% (strongly agreed or agreed). A majority (93%) would recommend the clinic to other veterans. Conclusions: This project successfully implemented a MHCVT pilot clinic. The veterans were satisfied with the services. The 41 clinic visits resulted in a potential cost savings. Expansion of this clinic in the future will expand more mental health resources to veterans.

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