Background: The Veterans Health Administration (VHA) of the Department of Veterans Affairs (VA) manages the largest integrated health care system in the U.S. Cancer is second only to cardiovascular disease as a cause of patient mortality and morbidity. In the fiscal year 1996, malignancies accounted for 49,270 primary diagnoses at the time of discharge from acute hospitals.
Methods: VHA recently developed a national, uniform benefits package that provides oncologic services of prevention and screening, inpatient and outpatient services, rehabilitative care, reconstructive surgery, home health care, respite, and hospice care. VA classifies all hospitals according to American College of Surgeons (ACS) Commission on Cancer criteria and standards. One hundred four of 173 facilities are ACS-approved cancer centers. Eighty-six VA hospitals have cancer registries.
Results: VHA has developed a Prevention Index (PI) that consists of nine measures for prevention and early detection of influenza and pneumococcal diseases, tobacco consumption, alcohol abuse, and cancers of the breast, cervix, colon, and prostate. All cancer interventions in the PI showed substantial increases between 1996 and 1997, and all exceeded U.S. Public Health Healthy People 2000 goals. The Veterans Health Administration's performance measure regarding end-of-life planning calls for 95% of eligible patients to receive ongoing care. Current baseline performance is 52% nationally. Measures of patient satisfaction for oncology patients show overall satisfaction at 87%.
Conclusions: The VA healthcare system has substantial expertise in the diagnosis and management of cancer. VHA's unprecedented transformation into a system of integrated networks supports and promotes that expertise. The VHA initiatives described in this article are synergistically working to enhance the consistency and comprehensiveness of high-quality, patient-centered oncologic services.