Cooper G S, Yuan Z, Stange K C, Dennis L K, Amini S B, Rimm A A
Department of Medicine, Case Western Reserve University, Cleveland, Ohio, USA.
Med Care. 2000 Apr;38(4):411-21. doi: 10.1097/00005650-200004000-00008.
Although health claims data are increasingly used in evaluating variations in patterns of cancer care and outcomes, little is known about the comparability of these data with tumor registry information.
To evaluate the agreement between Medicare claims and tumor registry data in measuring patterns of diagnostic and therapeutic procedures for older cancer patients.
Analysis of a database linking Surveillance, Epidemiology and End Results (SEER) registry data and Medicare claims in patients aged > or =65 years with cancer.
361,255 Medicare patients with invasive breast, colorectal, endometrial, lung, pancreatic, and prostate cancer diagnosed between 1984 and 1993.
Concordance of SEER files with corresponding Medicare claims.
Medicare claims generally identified patients who underwent resection and radical surgery according to SEER (ie, concordance > or =85%-90%) but less likely biopsy or local excision (ie, concordance < or =50%). In some instances, claims also categorized patients as having more invasive surgery than was listed in SEER and also provided incremental information about the use of surgical treatment after 4 months. SEER files and, to a lesser degree, Medicare claims identified radiation therapy not included in the other data source, and Medicare files also captured a significant number of patients with codes for chemotherapy.
Medicare files may be appropriate for studies of patterns of use of surgical treatment, but not for diagnostic procedures. The potential benefit of Medicare claims in identifying delayed surgical intervention and chemotherapy deserves further study.
尽管健康声明数据越来越多地用于评估癌症治疗模式和结果的差异，但对于这些数据与肿瘤登记信息的可比性知之甚少。
评估医疗保险声明与肿瘤登记数据在测量老年癌症患者诊断和治疗程序模式方面的一致性。
对一个数据库进行分析，该数据库将监测、流行病学和最终结果（SEER）登记数据与年龄≥65岁的癌症患者的医疗保险声明相链接。
1984年至1993年间诊断为浸润性乳腺癌、结直肠癌、子宫内膜癌、肺癌、胰腺癌和前列腺癌的361,255名医疗保险患者。
SEER文件与相应医疗保险声明的一致性。
医疗保险声明通常能识别出根据SEER进行了切除和根治性手术的患者（即一致性≥85%-90%），但识别活检或局部切除患者的可能性较小（即一致性≤50%）。在某些情况下，声明还将患者分类为接受了比SEER列出的更具侵入性的手术，并且还提供了4个月后手术治疗使用情况的增量信息。SEER文件以及在较小程度上医疗保险声明识别出了其他数据源未包括的放射治疗，医疗保险文件还记录了大量有化疗代码的患者。
医疗保险文件可能适用于手术治疗使用模式的研究，但不适用于诊断程序。医疗保险声明在识别延迟手术干预和化疗方面的潜在益处值得进一步研究。
