USING CLAIMS DATA FOR CANCER SURVEILLANCE

使用索赔数据进行癌症监测

• 批准号: 2010064
• 负责人: LYNNE T PENBERTHY
• 金额: $ 38.8万
• 依托单位: VIRGINIA COMMONWEALTH UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 1997
• 资助国家: 美国
• 起止时间: 1997-03-17 至 2000-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/2010064
• 关键词: Medicare /Medicaid; cancer registry /resource; data collection methodology /evaluation; human data; information systems; mathematical model; medical records; neoplasm /cancer epidemiology

DESCRIPTION: The overall purpose of this study is to examine the utility and validity of linking data from three claims-based sources to the Virginia Cancer Registry (VCR) for cancer surveillance. The study will focus on the five leading cancers in Virginia: breast, cervical, colorectal, lung, and prostate. The three claims-based files to be linked to the VCR are: Medicare, Medicaid, and the statewide hospital discharge summary files. Because of its high incidence, devastating impact, and potential preventability, monitoring cancer epidemiology is essential. An effective cancer surveillance program could help track groups at high risk for the disease and assess the value of interventions, such as screening. Surveillance mechanisms must produce information in a timely fashion to be useful to policy makers who are deciding about allocation of limited health care resources. Claims files offer an important potential source of routinely available, population-based, computer readable information that could supplement the cancer surveillance activities of statewide registries. These databases, however, have the limitations of minimal clinical content and association with billing activities. Accuracy of diagnosis coding is a particular concern, although one study indicated good accuracy for cancer diagnoses. Despite these limitations, linking claims files to cancer registries could capture more cancer incident cases and add to understanding of cancer care. Four databases will be linked in this study: 1. The Virginia Cancer Registry (VCR). Until 1990, reporting to the VCR was voluntary and included half the hospitals in Virginia; starting in 1990, reporting of cancer incident cases became mandatory. About 85% of the cases are reported by hospitals that include complete staging data; 2. Medicare files for Parts A and B, including all institutional and noninstitutional bills; 3. Virginia Medicaid files, including inpatient, outpatient, and pharmacy claims. The Medicaid files contain a large number of minority (46% black) and high risk patients; and 4. Virginia Health Information (VHI) files. Since 1993, VHI has maintained inpatient claims for all admissions to Virginia hospitals. To address the first Specific Aim, the latter three claims-based files will be linked to the VCR at the person level using AUTOMATCH, a product of Match Ware Technologies for probabilistic record linkages. The second specific Aim involves validating methods for identifying cancer incidence from the three claims files and assessing the reliability and validity of incidence and treatment data in the four data sources. Data will be abstracted from inpatient medical records and outpatient health care providers, and from reviewing laboratory, radiation treatment, and outpatient chemotherapy logs. A stratified random sample of 2,750 patients will be drawn, with the sampling protocol considering the likelihood that patients will be flagged as a cancer case by more than one of the data sources. Strata were created based on the data source of the sampled case (Figure 1, p. 52); sampled cases will be clustered within hospitals. Abstraction of inpatient records will be performed by the Virginia Health Quality Center, the state peer review organization. Collection of outpatient information will have four approaches: 1. A survey will be mailed to physicians from the VCR asking about the treatment given to a specified patient; 2. When physicians fail to respond to the mail survey, the hospital tumor registrar will contact physicians to get them to respond by mail or agree to a telephone interview; 3. Outpatient medical records will be abstracted for a random 10% sample of the 2,750 patients. The purpose of the validation is to judge the accuracy of the physicians' mailed responses. A VCR representative (a trained RN nurse abstractor) will conduct these reviews; and 4. For each hospital in the cluster sample, logs from pathology, radiotherapy, and chemotherapy units will be reviewed. Information from the primary data collection will be compared to that of the four data sources to assess their accuracy. The primary data will serve as the "gold standard" in determining the sensitivity and predictive values positive and negative of the four data files. The areas that will be examined include the definition of incident cases and initial surgical and nonsurgical treatment. An analysis will be performed to assess the representativeness of the different data sources in identifying cancer cases, using as a framework a Venn diagram showing potential overlap and discordance. The completeness of a surveillance approach combining all data sources will also be assessed by estimating the frequency of missed cases using capture-recapture techniques developed by naturalists. To assess further false negatives and the value of the capture-recapture method, a pilot study will be performed at Medical College of Virginia and three associated rural hospitals, combing all primary data sources and billing data to identify all cancer cases. The outcome of this project will be a clear sense, at least for Virginia, about the utility of linking administrative data files to a cancer registry for examining the incidence and initial treatment of cancer.

描述：这项研究的总体目的是检查实用程序 将来自三个基于索赔的来源的数据链接到弗吉尼亚的有效性 癌症登记局（VCR）进行癌症监测。 该研究将重点放在 弗吉尼亚州的五种主要癌症：乳房，宫颈，结直肠，肺和 前列腺。 要链接到VCR的三个基于索赔的文件是： Medicare，Medicaid和全州医院出院摘要文件。 由于其发病率很高，毁灭性影响和潜力 预防性，监测癌症流行病学至关重要。 有效 癌症监视计划可以帮助追踪面临高风险的群体 疾病并评估干预措施的价值，例如筛查。 监视机制必须及时产生信息 对于决定分配有限健康的政策制定者有用 护理资源。 索赔文件提供了常规可用的重要潜在来源， 基于人群的计算机可读信息，可以补充 全州登记处的癌症监测活动。 这些数据库， 但是，有最低临床含量和关联的局限性 进行计费活动。 诊断编码的准确性是特定的 令人担忧，尽管一项研究表明癌症诊断的准确性良好。 尽管有这些限制，将索赔文件链接到癌症注册机构可以 捕获更多的癌症事件病例，并增加对癌症护理的了解。 这项研究将链接四个数据库：1。弗吉尼亚癌症 注册表（VCR）。 直到1990年，向VCR报告是自愿的，包括 弗吉尼亚州的一半医院；从1990年开始，报告癌症 事件案件成为强制性。 约85％的案件报告 包括完整分期数据的医院； 2。零件的医疗保险文件 和B，包括所有机构和非机构法案； 3。弗吉尼亚 医疗补助文件，包括住院，门诊和药房索赔。 这 医疗补助文件包含大量少数（46％黑色）和高风险 患者;和4。弗吉尼亚健康信息（VHI）文件。 自1993年以来，VHI 对弗吉尼亚医院的所有入院都保持了住院要求。 为了解决第一个特定目标，后三个基于索赔的文件将 使用Automatch链接到人级别的VCR，这是匹配的产品 概率记录联系的Ware Technologies。 第二个特定目的涉及验证鉴定癌症的方法 三个索赔文件的发病率并评估可靠性和 四个数据源中发病率和治疗数据的有效性。 数据 将从住院病历和门诊医疗保健中抽象 提供者，以及审查实验室，放射治疗和 门诊化疗原木。 2,750例患者的分层随机样本 将通过采样协议来绘制，考虑到的可能性 多个数据将被标记为癌症病例 来源。 根据采样情况的数据源创建地层 （图1，第52页）;采样病例将聚集在医院中。 弗吉尼亚州健康将进行住院记录的抽象 质量中心，州同行评审组织。 收集 门诊信息将有四种方法：1。调查将是 邮寄给VCR的医生，询问给予的治疗 指定的患者； 2。当医生无法回应邮件调查时 医院肿瘤注册商将与医生联系以使他们回应 通过邮件或同意电话采访； 3。门诊病记录 将对2,750例患者的随机样本进行抽象。 这 验证的目的是判断医生邮寄的准确性 回答。 VCR代表（训练有素的RN护士摘要）将 进行这些评论；和4。对于集群样本中的每个医院，日志 从病理学，放疗和化学疗法单元中进行审查。 将主要数据收集的信息与 四个数据源评估其准确性。 主要数据将作为 确定灵敏度和预测值的“黄金标准” 四个数据文件的正面和负数。 将是 所检查的包括事件病例和初始手术的定义以及 非外科治疗。 将进行分析以评估 不同数据源在识别癌症方面的代表性 案例，用作框架的维恩图显示了潜在的重叠和 不和谐。 结合所有数据的监视方法的完整性 来源也将通过估计错失病例的频率进行评估 使用博物学家开发的捕获回收技术。 评估 进一步的假否定性和捕获回合方法的价值，一个 试点研究将在弗吉尼亚医学院和三个 相关的农村医院，梳理所有主要数据来源和计费 数据以识别所有癌症病例。 这个项目的结果将是一种明显的意义，至少对于弗吉尼亚州而言， 关于将管理数据文件链接到癌症注册表的效用 用于检查癌症的发病率和初始治疗。