Effect of travel distance and rurality of residence on initial surveillance for hepatocellular carcinoma in VA primary care patient with cirrhosis
Corresponding Author
Yolanda Rodriguez Villalvazo MD, MPH
Center for Access and Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa
Iowa City VA Healthcare System, Iowa City, Iowa
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Correspondence
Yolanda Rodriguez Villalvazo, MD, MPH, Comprehensive Access and Delivery Research & Evaluation (CADRE) Center, Iowa City VA Healthcare System, 601 HWY 6 West, Mailcode 111, Building 1, Iowa City, Iowa 52242.
Email: [email protected]
Search for more papers by this authorJennifer S. McDanel PhD
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorLauren A. Beste MD, MSc
General Medicine Service and Health Services Research and Development, Seattle, Washington
VA Puget Sound Health Care System, Seattle, Washington
Department of Medicine, University of Washington School of Medicine, Seattle, Washington
Search for more papers by this authorAntonio J. Sanchez MD
Department of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorMary Vaughan-Sarrazin PhD
Center for Access and Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorDavid A. Katz MD, MSc
Center for Access and Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa
Iowa City VA Healthcare System, Iowa City, Iowa
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorCorresponding Author
Yolanda Rodriguez Villalvazo MD, MPH
Center for Access and Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa
Iowa City VA Healthcare System, Iowa City, Iowa
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Correspondence
Yolanda Rodriguez Villalvazo, MD, MPH, Comprehensive Access and Delivery Research & Evaluation (CADRE) Center, Iowa City VA Healthcare System, 601 HWY 6 West, Mailcode 111, Building 1, Iowa City, Iowa 52242.
Email: [email protected]
Search for more papers by this authorJennifer S. McDanel PhD
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorLauren A. Beste MD, MSc
General Medicine Service and Health Services Research and Development, Seattle, Washington
VA Puget Sound Health Care System, Seattle, Washington
Department of Medicine, University of Washington School of Medicine, Seattle, Washington
Search for more papers by this authorAntonio J. Sanchez MD
Department of Gastroenterology and Hepatology, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorMary Vaughan-Sarrazin PhD
Center for Access and Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorDavid A. Katz MD, MSc
Center for Access and Delivery Research & Evaluation (CADRE), Iowa City VA Healthcare System, Iowa City, Iowa
Iowa City VA Healthcare System, Iowa City, Iowa
Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, Iowa
Search for more papers by this authorAbstract
Objective
To determine the relationship between travel distance and surveillance for hepatocellular carcinoma among veterans with cirrhosis.
Data Sources
Veterans Health Administration (VHA) inpatient and outpatient administrative data were linked to geocoded enrollee files. CMS-VHA merged data were used to assess receipt of Medicare-financed non-VA imaging.
Study Design
A retrospective cohort of US veterans diagnosed with cirrhosis between 2009 and 2015 was examined. First available abdominal imaging following the diagnosis of cirrhosis was analyzed separately as a function of travel distance to the nearest VA medical center (VAMC) and to the patient's assigned VA primary care provider. Veterans with dual use of Medicare and VA services were also examined for receipt of imaging outside of the VA.
Principal Findings
Veterans who resided more than 30 miles from the nearest VAMC were less likely to receive any imaging for HCC surveillance. Among dual users, increased travel distance between the patient's residence and nearest VAMC was associated with an increased likelihood of receiving any abdominal imaging at non-VA facilities.
Conclusion
Increased travel distance to the nearest VA medical center reduces the likelihood of receiving imaging for HCC surveillance in cirrhotic veterans. Future efforts should focus on reducing geographic barriers to HCC surveillance.
Supporting Information
| Filename | Description |
|---|---|
| hesr13241-sup-0001-Authormatrix.pdfPDF document, 377.5 KB | |
| hesr13241-sup-0002-FigS1-S2.docxWord document, 110 KB | |
| hesr13241-sup-0003-TableS1-S5.docxWord document, 27.1 KB |
Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.
REFERENCES
- 1Ferlay J, Soerjomataram I, Dikshit R, et al. Cancer incidence and mortality worldwide: sources, methods and major patterns in GLOBOCAN 2012. Int J Cancer. 2015; 136(5): E359-E386.
- 2El-Serag HB. Hepatocellular carcinoma. N Engl J Med. 2011; 365(12): 1118-1127.
- 3Alketruse SF, Kosary C, Krapcho M, et al. SEER Cancer Statistics Review, 1975–2007. Bethesda, MD: National Cancer Institute; 2010.
- 4Altekruse SF, McGlynn KA, Reichman ME. Hepatocellular carcinoma incidence, mortality, and survival trends in the United States from 1975 to 2005. J Clin Oncol. 2009; 27(9): 1485-1491.
- 5Xu J. Trends in liver cancer mortality among adults aged 25 and over in the United States, 2000–2016. NCHS Data Brief. 2018; 314: 1-8.
- 6Siegel R, Naishadham D, Jemal A. Cancer statistics, 2013. CA Cancer J Clin. 2013; 63(1): 11-30.
- 7Bruix J, Sherman M. Management of hepatocellular carcinoma. Hepatology. 2005; 42(5): 1208-1236.
- 8Garcia-Tsao G, Lim JK. Management and treatment of patients with cirrhosis and portal hypertension: recommendations from the Department of Veterans Affairs Hepatitis C Resource Center Program and the National Hepatitis C Program. Am J Gastroenterol. 2009; 104(7): 1802-1829.
- 9Heimbach JK, Kulik LM, Finn RS, et al. AASLD guidelines for the treatment of hepatocellular carcinoma. Hepatology. 2018; 67(1): 358-380.
- 10Davila JA, Morgan RO, Richardson PA, Du XL, McGlynn KA, El-Serag HB. Use of surveillance for hepatocellular carcinoma among patients with cirrhosis in the United States. Hepatology. 2010; 52(1): 132-141.
- 11Singal AG, El-Serag HB. Hepatocellular carcinoma from epidemiology to prevention: translating knowledge into practice. Clin Gastroenterol Hepatol. 2015; 13(12): 2140-2151.
- 12Stravitz RT, Heuman DM, Chand N, et al. Surveillance for hepatocellular carcinoma in patients with cirrhosis improves outcome. Am J Med. 2008; 121(2): 119-126.
- 13Patwardhan V, Paul S, Corey KE, et al. Hepatocellular carcinoma screening rates vary by etiology of cirrhosis and involvement of gastrointestinal sub-specialists. Dig Dis Sci. 2011; 56(11): 3316-3322.
- 14Singal AG, Volk ML, Rakoski MO, et al. Patient involvement in healthcare is associated with higher rates of surveillance for hepatocellular carcinoma. J Clin Gastroenterol. 2011; 45(8): 727-732.
- 15Wong CR, Garcia RT, Trinh HN, et al. Adherence to screening for hepatocellular carcinoma among patients with cirrhosis or chronic hepatitis B in a community setting. Dig Dis Sci. 2009; 54(12): 2712-2721.
- 16Artinyan A, Mailey B, Sanchez-Luege N, et al. Race, ethnicity, and socioeconomic status influence the survival of patients with hepatocellular carcinoma in the United States. Cancer. 2010; 116(5): 1367-1377.
- 17Davila JA, Weston A, Smalley W, El-Serag HB. Utilization of screening for hepatocellular carcinoma in the United States. J Clin Gastroenterol. 2007; 41(8): 777-782.
- 18Goldberg DS, Taddei TH, Serper M, et al. Identifying barriers to hepatocellular carcinoma surveillance in a national sample of patients with cirrhosis. Hepatology. 2017; 65(3): 864-874.
- 19Rongey C, Shen H, Hamilton N, Backus LI, Asch SM, Knight S. Impact of rural residence and health system structure on quality of liver care. PLoS ONE. 2013; 8(12):e84826.
- 20Farmer CM, Hosek SD, Adamson DM. Balancing demand and supply for Veterans' Health Care: a summary of three RAND assessments conducted under the Veterans Choice Act. Rand Health Q. 2016; 6(1): 12.
- 21Rogers H, Lantham T, Walorski JHR. H.R. 3230. Veterans access, choice, and accountability act of 2014. In: Representatives USHo, ed. Public Law. Washington, DC; 2014: 113-146. https://www.congress.gov/bill/113thcongress/house-bill/3230/related-bills
- 22Aday LA, Andersen R. A framework for the study of access to medical care. Health Serv Res. 1974; 9(3): 208-220.
- 23Fortney JC, Burgess JF Jr, Bosworth HB, Booth BM, Kaboli PJ. A re-conceptualization of access for 21st century healthcare. J Gen Intern Med. 2011; 26(Suppl. 2): 639-647.
- 24 Department of Veterans Affairs. Beneficiary travel under 38 U.S.C. 111 within the Unites. Final rule. Fed Regist. 2008; 73(126): 36796-36802.
- 25Kramer JR, Davila JA, Miller ED, Richardson P, Giordano TP, El-Serag HB. The validity of viral hepatitis and chronic liver disease diagnoses in Veterans Affairs administrative databases. Aliment Pharmacol Ther. 2008; 27(3): 274-282.
- 26Hynes DM, Cowper DC, Manheim L, et al. Research Findings from the VA Medicare Data Merge Initiative: Veteran's Enrollment, Access and Use of Medicare and VA Health Services (XVA 69–001). Report to the Under Secretary for Health, Department of Veteran Affairs. Hines, IL: VA Information Resource Center, Health Services Research and Development Service; 2003.
- 27Burgess JF Jr, DeFiore DA. The effect of distance to VA facilities on the choice and level of utilization of VA outpatient services. Soc Sci Med. 1994; 39(1): 95-104.
- 28Phibbs CSCE, Fan AY. Guide to the PSSG Enrollee File. Menlo Park, CA: VA Palo Alto, Health Economics Research Center; 2013.
- 29West AN, Lee RE, Shambaugh-Miller MD, et al. Defining “rural” for veterans' health care planning. J Rural Health. 2010; 26(4): 301-309.
- 30Gagne JJ, Glynn RJ, Avorn J, Levin R, Schneeweiss S. A combined comorbidity score predicted mortality in elderly patients better than existing scores. J Clin Epidemiol. 2011; 64(7): 749-759.
- 31Austin PC. A tutorial on multilevel survival analysis: methods, models and applications. Int Stat Rev. 2017; 85(2): 185-203.
- 32Katz MH, Hauck WW. Proportional hazards (Cox) regression. J Gen Intern Med. 1993; 8(12): 702-711.
- 33Newgard CD, Haukoos JS. Advanced statistics: missing data in clinical research–part 2: multiple imputation. Acad Emerg Med. 2007; 14(7): 669-678.
- 34Singal AG, Yopp A, Celette SS, Packer M, Lee WM, Tiro JA. Utilization of hepatocellular carcinoma surveillance among American patients: a systematic review. J Gen Intern Med. 2012; 27(7): 861-867.
- 35Wang F. Measurement, optimization, and impact of health care accessibility: a methodological review. Ann Assoc Am Geogr. 2012; 102(5): 1104-1112.
- 36Anderson AE, Henry KA, Samadder NJ, Merrill RM, Kinney AY. Rural vs urban residence affects risk-appropriate colorectal cancer screening. Clin Gastroenterol Hepatol. 2013; 11(5): 526-533.
- 37Fan L, Mohile S, Zhang N, Fiscella K, Noyes K. Self-reported cancer screening among elderly Medicare beneficiaries: a rural-urban comparison. J Rural Health. 2012; 28(3): 312-319.
- 38Nelson RE, Hicken B, Vanneman M, Liu CF, Rupper R. The impact of a change in the price of VA Health Care on utilization of VA and Medicare Services. Med Care. 2018; 56(7): 569-576.
- 39Marrero JA, Ahn J, Reddy RK. ACG clinical guideline: the diagnosis and management of focal liver lesions. Am J Gastroenterol. 2014; 109(9): 1328-1347; quiz 1348.
- 40Zhang BH, Yang BH, Tang ZY. Randomized controlled trial of screening for hepatocellular carcinoma. J Cancer Res Clin Oncol. 2004; 130(7): 417-422.
- 41Kansagara D, Papak J, Jou JH. Screening for hepatocellular carcinoma in chronic liver disease. Ann Intern Med. 2015; 162(3): 240.
- 42El-Serag HB, Kanwal F. Epidemiology of hepatocellular carcinoma in the United States: where are we? Where do we go? Hepatology. 2014; 60(5): 1767-1775.
- 43Mancebo A, Gonzalez-Dieguez ML, Cadahia V, et al. Annual incidence of hepatocellular carcinoma among patients with alcoholic cirrhosis and identification of risk groups. Clin Gastroenterol Hepatol. 2013; 11(1): 95-101.
- 44Fattovich G, Stroffolini T, Zagni I, Donato F. Hepatocellular carcinoma in cirrhosis: incidence and risk factors. Gastroenterology. 2004; 127(5 Suppl. 1): S35-S50.
- 45Beste LA, Harp BK, Blais RK, Evans GA, Zickmund SL. Primary care providers report challenges to cirrhosis management and specialty care coordination. Dig Dis Sci. 2015; 60(9): 2628-2635.
- 46Beste LA, Glorioso TJ, Ho PM, et al. Telemedicine specialty support promotes hepatitis C treatment by primary care providers in the Department of Veterans Affairs. Am J Med. 2017; 130(4): 432.e3-438.e3.
- 47Serper M, Volk ML. Current and future applications of telemedicine to optimize the delivery of care in chronic liver disease. Clin Gastroenterol Hepatol. 2018; 16(2): 157.e8-161.e8.
- 48Glass LM, Waljee AK, McCurdy H, Su GL, Sales A. Specialty care access network-extension of community healthcare outcomes model program for liver disease improves specialty care access. Dig Dis Sci. 2017; 62(12): 3344-3349.
- 49Su GL, Glass L, Tapper EB, Van T, Waljee AK, Sales AE. Virtual consultations through the Veterans Administration SCAN-ECHO Project improves survival for Veterans with liver disease. Hepatology. 2018; 68(6): 2317-2324.
- 50Piao C, Terrault NA, Sarkar S. Telemedicine: an evolving field in hepatology. Hepatol Commun. 2019; 3(5): 716-721.
- 51Salami AC, Barden GM, Castillo DL, et al. Establishment of a regional virtual tumor board program to improve the process of care for patients with hepatocellular carcinoma. J Oncol Pract. 2015; 11(1): e66-e74.
- 52Schiff GD, Hasan O, Kim S, et al. Diagnostic error in medicine: analysis of 583 physician-reported errors. Arch Intern Med. 2009; 169(20): 1881-1887.
- 53Kanwal F, Mapaskhi S, Smith D, et al. Implementation of a population-based cirrhosis identification and management system. Clin Gastroenterol Hepatol. 2018; 16(8): 1182.e2-1186.e2.
- 54Kanwal F, Kramer JR, Buchanan P, et al. The quality of care provided to patients with cirrhosis and ascites in the Department of Veterans Affairs. Gastroenterology. 2012; 143(1): 70-77.
- 55Carrier E, Dowling MK, Pham HH. Care coordination agreements: barriers, facilitators, and lessons learned. Am J Manag Care. 2012; 18(11): e398-e404.
- 56Fintelmann FJ, Bernheim A, Digumarthy SR, et al. The 10 pillars of lung cancer screening: rationale and logistics of a lung cancer screening program. Radiographics. 2015; 35(7): 1893-1908.
- 57Beste LA, Ioannou GN, Yang Y, Chang MF, Ross D, Dominitz JA. Improved surveillance for hepatocellular carcinoma with a primary care-oriented clinical reminder. Clin Gastroenterol Hepatol. 2015; 13(1): 172-179.
- 58Bornemann P, Bornemann G. Military family physicians' perceptions of a pocket point-of-care ultrasound device in clinical practice. Mil Med. 2014; 179(12): 1474-1477.
Citing Literature
