癌症分期后 PET 检查的意向性与推断性治疗：与有证据开发登记处的保险范围相关的医疗保险索赔分析。
Intended versus inferred management after PET for cancer restaging: analysis of Medicare claims linked to a coverage with evidence development registry.
机构信息
Department of Internal Medicine and the Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
出版信息
Med Care. 2013 Apr;51(4):361-7. doi: 10.1097/MLR.0b013e318287d860.
BACKGROUND
The National Oncologic PET Registry (NOPR) ascertained changes in the intended management of cancer patients using questionnaire data obtained before and after positron emission tomography (PET) under Medicare's coverage with evidence development policy.
OBJECTIVE
To assess the concordance between intended care plans and care received as ascertained through administrative claims data.
RESEARCH DESIGN
Analysis of linked data of NOPR participants from 2006 to 2008 and their corresponding Medicare claims.
SUBJECTS
Consenting patients aged older than 65 years having their first PET for restaging of bladder, kidney, ovarian, pancreas, prostate, small cell lung, or stomach cancer.
MEASURES
: Agreement (positive predictive values and κ) between NOPR post-PET intended management plans for treatment (systemic therapy, radiotherapy, surgery, or combinations), biopsy, or watching as compared to claims-inferred care 30 days after PET.
RESULTS
A total of 8460 patients with linked data were assessed. A total of 43.5% had metastatic disease and 45.3% had treatment planned (predominantly systemic therapy only), 11.1% biopsy and 43.5% watching. Claims-confirmed intended plans (positive predictive value) for single-mode systemic therapy in 62.0%, radiation in 66.0%, surgery in 45.6%, and biopsy in 55.7%. A total of 25.7% of patients with a plan of watching had treatment claims. By cancer type, κ ranged for systemic therapy only from 0.17 to 0.40 and for watching from 0.21 to 0.41. Agreement rates varied by cancer types but were minimally associated with patient age, performance status, comorbidity, or stage.
CONCLUSIONS
Among elderly cancer patients undergoing PET for restaging, there was moderate concordance between their physicians' planned management and claims-inferred actions within a narrow time window. When higher accuracy levels are required in future coverage with evidence development studies, alternative designs will be needed.
背景
国家肿瘤 PET 注册中心（NOPR）通过医疗保险的循证开发政策下的正电子发射断层扫描（PET）前后获得的问卷调查数据，确定了癌症患者的治疗管理意向变化。
目的
评估通过行政索赔数据确定的意向护理计划与实际接受的护理之间的一致性。
研究设计
对 2006 年至 2008 年 NOPR 参与者的相关数据以及他们相应的医疗保险索赔数据进行的链接分析。
受试者
年龄大于 65 岁，首次进行 PET 以重新分期膀胱癌、肾癌、卵巢癌、胰腺癌、前列腺癌、小细胞肺癌或胃癌的患者。
测量指标
与 PET 后 30 天索赔推断的护理相比，NOPR 后 PET 治疗（全身治疗、放疗、手术或联合治疗）、活检或观察意向管理计划的一致性（阳性预测值和 κ）。
结果
共评估了 8460 例具有链接数据的患者。43.5%的患者患有转移性疾病，45.3%的患者计划接受治疗（主要是全身治疗），11.1%的患者接受活检，43.5%的患者观察。在 62.0%的患者中，单一模式全身治疗、66.0%的患者中接受放疗、45.6%的患者接受手术和 55.7%的患者接受活检，索赔证实的意向计划（阳性预测值）得到确认。共有 25.7%的观察计划患者接受了治疗。按癌症类型划分，仅全身治疗的 κ 值范围为 0.17 至 0.40，观察的 κ 值范围为 0.21 至 0.41。不同癌症类型的一致性率有所不同，但与患者年龄、表现状态、合并症或分期的相关性很小。
结论
在接受 PET 重新分期的老年癌症患者中，在一个狭窄的时间窗口内，医生计划的管理与索赔推断的行动之间存在中等程度的一致性。在未来的循证开发研究中需要更高的准确性水平时，将需要替代设计。
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