Hospital Characteristics Associated with Timeliness of Care in Veterans with Lung Cancer

Rationale: Timeliness is one of six important dimensions ofhealth care quality recognized by the Institute of Medicine.Objectives: To evaluate timeliness of lung cancer care andidentify institutional characteristics associated with timelycare within the VA Health Care System. Methods: We used datafrom a VA nation-wide retrospective chart review and an independentaudit of VA cancer programs to examine the association betweentime to first treatment and potentially explanatory institutionalcharacteristics (e.g. volume of lung cancer patients) for 2,372veterans diagnosed with lung cancer between 1/1/02 and 9/1/05at 127 VA medical centers. We developed linear mixed effectsmodels to control for clustering of patients within hospitalsand stratified analyses by stage. Measurements and Main Results: Median time to treatment varied widely between (23 to 182 days)and within facilities. Median time to treatment was 90 daysin stage I or II patients and 52 days in those with more advanceddisease (p<0.0001). Factors associated with shorter timesto treatment included a non-academic setting and the existenceof a specialized diagnostic clinic (in patients with limitedstage disease), performing a patient flow analysis (in patientswith advanced disease), and leadership beliefs about providingtimely care (in both groups). However, institutional characteristicsexplained <1% of the observed variation in treatment times.Conclusions: Time to lung cancer treatment in U.S. veteransis highly variable. The numerous institutional characteristicswe examined explained relatively little of this variability,suggesting that patient, clinician, and/or unmeasured institutionalcharacteristics may be more important determinants of timelycare.