Department of Dermatology, Henry Ford Hospital, Detroit, Michigan 48202, USA.
J Invest Dermatol. 2012 Aug;132(8):2005-9. doi: 10.1038/jid.2012.98. Epub 2012 Apr 5.
Health maintenance organization (HMO) administrative databases have been used as sampling frames for ascertaining nonmelanoma skin cancer (NMSC). However, because of the lack of tumor registry information on these cancers, these ascertainment methods have not been previously validated. NMSC cases arising from patients served by a staff model medical group and diagnosed between 1 January 2007 and 31 December 2008 were identified from claims data using three ascertainment strategies. These claims data cases were then compared with NMSC identified using natural language processing (NLP) of electronic pathology reports (EPRs), and sensitivity, specificity, positive and negative predictive values were calculated. Comparison of claims data-ascertained cases with the NLP demonstrated sensitivities ranging from 48 to 65% and specificities from 85 to 98%, with ICD-9-CM ascertainment demonstrating the highest case sensitivity, although the lowest specificity. HMO health plan claims data had a higher specificity than all-payer claims data. A comparison of EPR and clinic log registry cases showed a sensitivity of 98% and a specificity of 99%. Validation of administrative data to ascertain NMSC demonstrates respectable sensitivity and specificity, although NLP ascertainment was superior. There is a substantial difference in cases identified by NLP compared with claims data, suggesting that formal surveillance efforts should be considered.
健康维护组织（HMO）管理数据库已被用作确定非黑素瘤皮肤癌（NMSC）的抽样框架。然而，由于这些癌症缺乏肿瘤登记信息，这些确定方法以前没有得到验证。从 2007 年 1 月 1 日至 2008 年 12 月 31 日期间，从索赔数据中确定了由员工模式医疗集团服务的患者中发生的 NMSC 病例，并使用三种确定策略对这些病例进行了识别。然后，将这些索赔数据病例与使用电子病理学报告（EPR）的自然语言处理（NLP）确定的 NMSC 进行比较，并计算了敏感性、特异性、阳性预测值和阴性预测值。与 NLP 的索赔数据确定病例的比较表明，敏感性范围为 48%至 65%，特异性范围为 85%至 98%，ICD-9-CM 确定的敏感性最高，但特异性最低。HMO 健康计划的索赔数据比所有支付者的索赔数据具有更高的特异性。EPR 和诊所日志登记处病例的比较显示，敏感性为 98%，特异性为 99%。对行政数据进行 NMSC 确定的验证表明，尽管 NLP 确定的敏感性和特异性相当高，但具有良好的敏感性和特异性。NLP 确定的病例与索赔数据之间存在很大差异，表明应考虑进行正式监测。
