Jennifer R Brown

Publications (2)35.1 Total impact

• Article: Survival of older patients with cancer in the Veterans Health Administration versus fee-for-service Medicare.

  Mary Beth Landrum, Nancy L Keating, Elizabeth B Lamont, Samuel R Bozeman, Steven H Krasnow, Lawrence Shulman, Jennifer R Brown, Craig C Earle, Michael Rabin, Barbara J McNeil
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  ABSTRACT: The Veterans Health Administration (VHA) provides high-quality preventive chronic care and cancer care, but few studies have documented improved patient outcomes that result from this high-quality care. We compared the survival rates of older patients with cancer in the VHA and fee-for-service (FFS) Medicare and examined whether differences in the stage at diagnosis, receipt of guideline-recommended therapies, and unmeasured characteristics explain survival differences. We used propensity-score methods to compare all-cause and cancer-specific survival rates for men older than age 65 years who were diagnosed or received their first course of treatment for colorectal, lung, lymphoma, or multiple myeloma in VHA hospitals from 2001 to 2004 to similar FFS-Medicare enrollees diagnosed in Surveillance, Epidemiology, and End Results (SEER) areas in the same time frame. We examined the role of unmeasured factors by using sensitivity analyses. VHA patients versus similar FFS SEER-Medicare patients had higher survival rates of colon cancer (adjusted hazard ratio [HR], 0.87; 95% CI, 0.82 to 0.93) and non-small-cell lung cancer (NSCLC; HR, 0.91; 95% CI, 0.88 to 0.95) and similar survival rates of rectal cancer (HR, 1.05; 95% CI, 0.95 to 1.16), small-cell lung cancer (HR, 0.99; 95% CI, 0.93 to 1.05), diffuse large-B-cell lymphoma (HR, 1.02; 95% CI, 0.89 to 1.18), and multiple myeloma (HR, 0.92; 95% CI, 0.83 to 1.03). The diagnosis of VHA patients at earlier stages explained much of the survival advantages for colon cancer and NSCLC. Sensitivity analyses suggested that additional adjustment for the severity of comorbid disease or performance status could have substantial effects on estimated differences. The survival rate for older men with cancer in the VHA was better than or equivalent to the survival rate for similar FFS-Medicare beneficiaries. The VHA provision of high-quality care, particularly preventive care, can result in improved patient outcomes.
  Journal of Clinical Oncology 03/2012; 30(10):1072-9. · 18.37 Impact Factor
• Article: Quality of care for older patients with cancer in the Veterans Health Administration versus the private sector: a cohort study.

  Nancy L Keating, Mary Beth Landrum, Elizabeth B Lamont, Samuel R Bozeman, Steven H Krasnow, Lawrence N Shulman, Jennifer R Brown, Craig C Earle, William K Oh, Michael Rabin, Barbara J McNeil
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  ABSTRACT: The Veterans Health Administration (VHA) is the largest integrated health care system in the United States. Studies suggest that the VHA provides better preventive care and care for some chronic illnesses than does the private sector. To assess the quality of cancer care for older patients provided by the VHA versus fee-for-service Medicare. Observational study of patients with cancer that was diagnosed between 2001 and 2004 who were followed through 2005. VHA and non-VHA hospitals and office-based practices. Men older than 65 years with incident colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. Rates of processes of care for colorectal, lung, or prostate cancer; lymphoma; or multiple myeloma. Rates were adjusted by using propensity score weighting. Compared with the fee-for-service Medicare population, the VHA population received diagnoses of colon (P < 0.001) and rectal (P = 0.007) cancer at earlier stages and had higher adjusted rates of curative surgery for colon cancer (92.7% vs. 90.5%; P < 0.010), standard chemotherapy for diffuse large B-cell non-Hodgkin lymphoma (71.1% vs. 59.3%; P < 0.001), and bisphosphonate therapy for multiple myeloma (62.1% vs. 50.4%; P < 0.001). The VHA population had lower adjusted rates of 3-dimensional conformal or intensity-modulated radiation therapy for prostate cancer treated with external-beam radiation therapy (61.6% vs. 86.0%; P < 0.001). Adjusted rates were similar for 9 other measures. Sensitivity analyses suggest that if patients with cancer in the VHA system have more severe comorbid illness than other patients, rates for most indicators would be higher in the VHA population than in the fee-for-service Medicare population. This study included only older men and did not include information about performance status, severity of comorbid illness, or patient preferences. Care for older men with cancer in the VHA system was generally similar to or better than care for fee-for-service Medicare beneficiaries, although adoption of some expensive new technologies may be delayed in the VHA system. Department of Veterans Affairs.
  Annals of internal medicine 06/2011; 154(11):727-36. · 16.73 Impact Factor