Commission on Cancer, American College of Surgeons, Chicago, IL, USA.
J Am Coll Surg. 2013 Mar;216(3):428-37. doi: 10.1016/j.jamcollsurg.2012.12.016. Epub 2013 Jan 26.
Evaluating and improving the quality of cancer care requires complete information on cancer stage and treatment. Hospital-based registries are a key tool in this effort, but reports in the 1990s showed that they fail to identify a major fraction of outpatient-administered treatment, including chemotherapy, endocrine therapy, and radiation. This can limit their value for evaluating patterns and quality of care. To determine the completeness of registry data in more recent years, we linked administrative claims from 2 private payers in Ohio to the National Cancer Data Base and Ohio Cancer Incidence and Surveillance System.
Incident breast and colorectal cancers among Ohio residents diagnosed in 2004-2006 were identified from linkage of the National Cancer Data Base, Ohio Cancer Incidence and Surveillance System, and payer insurance claims using ICD-9 and CPT procedure codes, and ICD-9 diagnosis codes. Linkage was accomplished using patient demographics, surgery dates, and hospital facility. Treatment found in claims and registry data were compared and assessed using the κ statistic.
The analytic cohort included 2,552 breast and 822 colorectal cases. Results showed high agreement for breast surgery type, and moderately high agreement for colorectal surgery type. For breast cases, the registries captured 87% of chemotherapy, 86% of radiation, and 64% of endocrine treatment in claims. For colorectal cases, the registry captured 83% of chemotherapy and 84% of radiation in claims.
Hospital-based registries for breast and colon cancer diagnosed in 2004-2006 captured about 85% of radiation and chemotherapy data compared with claims data, a higher percentage than earlier reports. These findings provide direction and a cautionary note to those using registry data for study of patterns and quality of systemic and radiation therapy care.
评估和提高癌症护理质量需要全面了解癌症分期和治疗情况。医院为基础的登记处是这方面的重要工具，但 20 世纪 90 年代的报告显示，它们未能识别出很大一部分门诊治疗，包括化疗、内分泌治疗和放疗。这可能限制了它们在评估护理模式和质量方面的价值。为了确定近年来登记处数据的完整性，我们将俄亥俄州的两家私人支付者的行政索赔与国家癌症数据库以及俄亥俄州癌症发病率和监测系统联系起来。
通过使用 ICD-9 和 CPT 程序代码以及 ICD-9 诊断代码，从国家癌症数据库、俄亥俄州癌症发病率和监测系统以及支付者保险索赔中对 2004-2006 年间诊断的俄亥俄州居民的乳腺癌和结直肠癌病例进行链接，确定了事件性乳腺癌和结直肠癌病例。链接是通过患者人口统计学、手术日期和医院设施完成的。使用κ统计量比较和评估索赔和登记处数据中的治疗方法。
分析队列包括 2552 例乳腺癌和 822 例结直肠癌病例。结果表明，乳腺癌手术类型的一致性很高，结直肠癌手术类型的一致性较高。对于乳腺癌病例，登记处记录了索赔中 87%的化疗、86%的放疗和 64%的内分泌治疗。对于结直肠癌病例，登记处记录了索赔中 83%的化疗和 84%的放疗。
2004-2006 年间诊断的乳腺癌和结肠癌的医院为基础的登记处与索赔数据相比，大约记录了 85%的放疗和化疗数据，比早期报告的比例更高。这些发现为那些使用登记处数据研究系统治疗和放疗护理模式和质量的人提供了方向和警示。
