SEER 与医疗保险索赔数据的诊断日期一致性：对治疗的影响。

Diagnosis date agreement between SEER and Medicare claims data: impact on treatment.

机构信息

*Surveillance and Health Services Research program, American Cancer Society †Department of Health Policy and Management, Emory University, Atlanta, GA.

出版信息

Med Care. 2014 Jan;52(1):32-7. doi: 10.1097/MLR.0000000000000004.

DOI:10.1097/MLR.0000000000000004

PMID:24322987

Abstract

BACKGROUND

A prior assessment of concordance between the diagnosis month in SEER records and Medicare claims found reasonable agreement; however, no assessment of the impact of discordance on cancer treatment ascertainment was conducted.

OBJECTIVES

The aim of this study was to assess the concordance between the SEER diagnosis date (Sdx) and Medicare claim-derived diagnosis date and the impact of discordance on identification of treatment received.

METHODS

The first Medicare claim date with a cancer diagnosis (Mdx) was compared with the Sdx among patients diagnosed with breast, colorectal, or lung cancer. The Mdx was considered concordant with the Sdx if the Mdx was within 16 days. Claims within 4 months after both the Mdx and Sdx were examined to collect treatment information. Treatment rate agreement was measured by κ-statistics.

RESULTS

Among 50,731 breast, 51,025 colorectal, and 61,384 lung cancer patients, the Sdx and Mdx were concordant in 79%, 86%, and 73% of cases, respectively. Most discordant Mdx cases were identified in the month after the SEER diagnosis month. A small proportion of cases (7%-12%) preceded the SEER diagnosis month. Agreement for receipt of surgery was very good across all 3 cancer sites (κ>0.88) and was excellent for radiation therapy (κ>0.96).

CONCLUSIONS

Although most cases were concordant for both diagnosis date and treatment ascertainment, there was still a small proportion of cases discordant for both diagnosis date and treatment identification. This study underscores the importance of examining claims in the months preceding diagnosis in the SEER-Medicare dataset to ensure patients are appropriately selected for analysis.

摘要

背景

先前对 SEER 记录中的诊断月份与医疗保险索赔之间的一致性进行了评估，发现两者之间存在合理的一致性；然而，尚未评估不一致对癌症治疗确定的影响。

目的

本研究旨在评估 SEER 诊断日期（Sdx）与医疗保险索赔衍生诊断日期之间的一致性，并评估不一致对所接受治疗的确定的影响。

方法

在诊断为乳腺癌、结直肠癌或肺癌的患者中，将首次具有癌症诊断的医疗保险索赔日期（Mdx）与 Sdx 进行比较。如果 Mdx 在 16 天内，则认为 Mdx 与 Sdx 一致。在 Mdx 和 Sdx 之后的 4 个月内检查索赔记录以收集治疗信息。通过κ统计量来衡量治疗率的一致性。

结果

在 50731 例乳腺癌、51025 例结直肠癌和 61384 例肺癌患者中，Sdx 和 Mdx 分别在 79%、86%和 73%的病例中一致。大多数不一致的 Mdx 病例出现在 SEER 诊断月份之后的一个月内。一小部分病例（7%-12%）出现在 SEER 诊断月份之前。在所有 3 个癌症部位，手术治疗的接受情况都非常一致（κ>0.88），而放射治疗的接受情况则非常好（κ>0.96）。