Penberthy Lynne, McClish Donna, Manning Claudine, Retchin Sheldon, Smith Tom
Department of Internal Medicine, Division of Quality Health Care, and Massey Cancer Center, Medical College of Virginia of Virginia Commonwealth University, Richmond, Virginia 22398-0306, USA.
Med Care. 2005 Jul;43(7):705-12. doi: 10.1097/01.mlr.0000167176.41645.c7.
As cancer diagnosis and treatment has moved to the outpatient healthcare setting, traditional cancer surveillance tools are less effective for complete and unbiased capture of incident cases. This study evaluates the potential for Medicare data to supplement cancer surveillance in a unique manner by using a standard that is independent of a central cancer registry.
State cancer registry records were matched with Medicare data. Case validation included inpatient record abstraction combined with a mail/telephone survey of treating physicians. The positive predictive value (PPV), sensitivity (capture rate), and potential additional cases were calculated for 6 Medicare claims-based case definitions.
The PPV varied according to cancer site and definition, ranging from 70%-97% (prostate) to 87%-98% (breast). Sensitivity varied inversely with PPV, ranging from 51%-94% (breast) to 10%-88% (lung). The most important factors that predicted being missed by the registry were having no admission to an ACOS-certified hospital and no surgical treatment.
Medicare data represent a valid resource for supplementing state cancer registries in surveillance efforts. This potential is especially applicable to cancers predominantly diagnosed and treated outside the hospital setting.
随着癌症诊断和治疗已转向门诊医疗环境，传统的癌症监测工具在全面且无偏差地捕获新发病例方面效果欠佳。本研究通过使用独立于中央癌症登记处的标准，评估医疗保险数据以独特方式补充癌症监测的潜力。
将州癌症登记记录与医疗保险数据进行匹配。病例验证包括住院病历摘要以及对治疗医生的邮件/电话调查。针对6种基于医疗保险理赔的病例定义计算了阳性预测值（PPV）、灵敏度（捕获率）和潜在的额外病例数。
PPV因癌症部位和定义而异，范围从70% - 97%（前列腺癌）到87% - 98%（乳腺癌）。灵敏度与PPV呈反比，范围从51% - 94%（乳腺癌）到10% - 88%（肺癌）。预测登记处遗漏病例的最重要因素是未入住经ACOS认证的医院且未接受手术治疗。
医疗保险数据是补充州癌症登记处监测工作的有效资源。这种潜力尤其适用于主要在医院外诊断和治疗的癌症。
