Department of Family and Community Medicine and Center for Healthcare Research and Policy, University of California, Davis, Sacramento, California 95817, USA.
Cancer Epidemiol Biomarkers Prev. 2012 Aug;21(8):1344-7. doi: 10.1158/1055-9965.EPI-12-0406. Epub 2012 Jun 13.
While Medicare claims are a potential resource for clinical mammography research or quality monitoring, the validity of key data elements remains uncertain. Claims codes for digital mammography and computer-aided detection (CAD), for example, have not been validated against a credible external reference standard.
We matched Medicare mammography claims for women who received bilateral mammograms from 2003 to 2006 to corresponding mammography data from the Breast Cancer Surveillance Consortium (BCSC) registries in four U.S. states (N = 253,727 mammograms received by 120,709 women). We assessed the accuracy of the claims-based classifications of bilateral mammograms as either digital versus film and CAD versus non-CAD relative to a reference standard derived from BCSC data.
Claims data correctly classified the large majority of film and digital mammograms (97.2% and 97.3%, respectively), yielding excellent agreement beyond chance (κ = 0.90). Claims data correctly classified the large majority of CAD mammograms (96.6%) but a lower percentage of non-CAD mammograms (86.7%). Agreement beyond chance remained high for CAD classification (κ = 0.83). From 2003 to 2006, the predictive values of claims-based digital and CAD classifications increased as the sample prevalences of each technology increased.
Medicare claims data can accurately distinguish film and digital bilateral mammograms and mammograms conducted with and without CAD.
The validity of Medicare claims data regarding film versus digital mammography and CAD suggests that these data elements can be useful in research and quality improvement.
尽管医疗保险索赔是临床乳房 X 线摄影研究或质量监测的潜在资源，但关键数据元素的有效性仍不确定。例如，数字乳房 X 线摄影和计算机辅助检测 (CAD) 的索赔代码尚未经过可信的外部参考标准验证。
我们将 2003 年至 2006 年间接受双侧乳房 X 光检查的女性的医疗保险乳房 X 光检查索赔与来自美国四个州的乳腺癌监测联盟 (BCSC) 登记处的相应乳房 X 光检查数据进行了匹配（N = 253,727 张由 120,709 名女性接受的乳房 X 光片）。我们评估了基于索赔的双侧乳房 X 光检查分类的准确性，例如数字与胶片以及 CAD 与非 CAD，相对于来自 BCSC 数据的参考标准。
索赔数据正确分类了绝大多数胶片和数字乳房 X 光片（分别为 97.2%和 97.3%），超出了偶然的一致性（κ = 0.90）。索赔数据正确分类了绝大多数 CAD 乳房 X 光片（96.6%），但非 CAD 乳房 X 光片的比例较低（86.7%）。CAD 分类的一致性仍然很高（κ = 0.83）。从 2003 年到 2006 年，随着每种技术的样本患病率增加，基于索赔的数字和 CAD 分类的预测值也随之增加。
医疗保险索赔数据可以准确区分胶片和数字双侧乳房 X 光片以及使用和不使用 CAD 进行的乳房 X 光检查。
关于胶片与数字乳房 X 线摄影和 CAD 的医疗保险索赔数据的有效性表明，这些数据元素在研究和质量改进中可能很有用。
