Quality of Care in Veterans Affairs Health Care System In-Person and National TeleOncology Service-Delivered Care

The Veterans Affairs Health Administration (VA) has experience using telehealth (TH) to deliver care to 10 million enrolled Veterans for many clinical care needs. The VA National TeleOncology Service (NTO) was established in 2020 to provide specialized cancer services regardless of geography. We sought to compare quality in TH-delivered cancer services with traditional (TR) in-person VA care.

Using electronic health record data, we identified patients with an International Classification of Diseases-10 diagnostic code for an incident malignancy from December 2016 to March 2021 at early adopting sites providing both TR and TH care. We classified patients as TH users if they received TH services at least once for their cancer care. We gathered demographic, clinical, and treatment characteristics to calculate 25 Quality Oncology Practice Initiative (QOPI) measures in the symptoms and toxicity management (two), end of life and palliative care (10), and core measure domains (13). We report disease-specific measures, QOPI measures descriptively, and performed chi-square tests to compare TH and TR.

We identified 972 patients with lymphoma, prostate, lung, or colorectal cancer. In all, 427 (44%) were TH users. Patients were predominately White (n = 819, 84.3%) men (n = 930, 95.7%). Across 25 QOPI measures, TH users received better (n = 12), worse (n = 10), the same (n = 2), and unevaluable (n = 1) descriptive performance. Appropriate tobacco cessation support within the previous year was higher in TH (85.3% v 76.2%, P = .002). TH and TR rates were similar for the other QOPI measures.

VA is a leader in TH cancer care because of both its volume and quality. VA-provided TH cancer care quality is similar to or better than that of TR in-person care. NTO specifically, and VA teleoncology broadly, provides another option to Veterans for cancer care.