使用大规模电子健康记录数据评估癌症确诊策略的结构化方法
Structured Approach for Evaluating Strategies for Cancer Ascertainment Using Large-Scale Electronic Health Record Data.
作者信息
Earles Ashley, Liu Lin, Bustamante Ranier, Coke Pat, Lynch Julie, Messer Karen, Martínez María Elena, Murphy James D, Williams Christina D, Fisher Deborah A, Provenzale Dawn T, Gawron Andrew J, Kaltenbach Tonya, Gupta Samir
机构信息
Ashley Earles, Ranier Bustamante, and Samir Gupta, Veterans Affairs (VA) San Diego Healthcare System; Lin Liu, Karen Messer, María Elena Martínez, James D. Murphy, and Samir Gupta, University of California San Diego, San Diego; Tonya Kaltenbach, San Francisco VA Medical Center; Tonya Kaltenbach, University of California San Francisco, San Francisco, CA; Pat Coke, Central Arkansas Veterans Healthcare System, Little Rock, AR; Julie Lynch and Andrew J. Gawron, VA Salt Lake City Health Care System; Andrew J. Gawron, University of Utah, Salt Lake City, UT; Christina D. Williams, Deborah A. Fisher, and Dawn T. Provenzale, Durham VA Medical Center; and Christina D. Williams, Deborah A. Fisher, and Dawn T. Provenzale, Duke University, Durham, NC.
出版信息
JCO Clin Cancer Inform. 2018 Dec;2:1-12. doi: 10.1200/CCI.17.00072.
PURPOSE
Cancer ascertainment using large-scale electronic health records is a challenge. Our aim was to propose and apply a structured approach for evaluating multiple candidate approaches for cancer ascertainment using colorectal cancer (CRC) ascertainment within the US Department of Veterans Affairs (VA) as a use case.
METHODS
The proposed approach for evaluating cancer ascertainment strategies includes assessment of individual strategy performance, comparison of agreement across strategies, and review of discordant diagnoses. We applied this approach to compare three strategies for CRC ascertainment within the VA: administrative claims data consisting of International Classification of Diseases, Ninth Revision (ICD9) diagnosis codes; the VA Central Cancer Registry (VACCR); and the newly accessible Oncology Domain, consisting of cases abstracted by local cancer registrars. The study sample consisted of 1,839,043 veterans with index colonoscopy performed from 1999 to 2014. Strategy-specific performance was estimated based on manual record review of 100 candidate CRC cases and 100 colonoscopy controls. Strategies were further compared using Cohen's κ and focused review of discordant CRC diagnoses.
RESULTS
A total of 92,197 individuals met at least one CRC definition. All three strategies had high sensitivity and specificity for incident CRC. However, the ICD9-based strategy demonstrated poor positive predictive value (58%). VACCR and Oncology Domain had almost perfect agreement with each other (κ, 0.87) but only moderate agreement with ICD9-based diagnoses (κ, 0.51 and 0.57, respectively). Among discordant cases reviewed, 15% of ICD9-positive but VACCR- or Oncology Domain-negative cases had incident CRC.
CONCLUSION
Evaluating novel strategies for identifying cancer requires a structured approach, including validation against manual record review, agreement among candidate strategies, and focused review of discordant findings. Without careful assessment of ascertainment methods, analyses may be subject to bias and limited in clinical impact.
目的
利用大规模电子健康记录进行癌症确诊是一项挑战。我们的目标是提出并应用一种结构化方法，以美国退伍军人事务部（VA）内的结直肠癌（CRC）确诊为例，评估多种癌症确诊候选方法。
方法
所提出的评估癌症确诊策略的方法包括评估个体策略性能、比较各策略间的一致性以及审查不一致的诊断。我们应用此方法比较VA内的三种CRC确诊策略：由国际疾病分类第九版（ICD9）诊断代码组成的行政索赔数据；VA中央癌症登记处（VACCR）；以及新可获取的肿瘤学领域，该领域由当地癌症登记员提取的病例组成。研究样本包括1999年至2014年接受索引结肠镜检查的1,839,043名退伍军人。基于对100例候选CRC病例和100例结肠镜检查对照的人工记录审查，估计各策略的特定性能。使用科恩κ系数进一步比较各策略，并重点审查不一致的CRC诊断。
结果
共有92,197人符合至少一项CRC定义。所有三种策略对新发CRC均具有高敏感性和特异性。然而，基于ICD9的策略显示出较差的阳性预测值（58%）。VACCR和肿瘤学领域彼此之间几乎完全一致（κ，0.87），但与基于ICD9的诊断仅具有中等一致性（κ分别为0.51和0.57）。在审查的不一致病例中，15%的ICD9阳性但VACCR或肿瘤学领域阴性的病例患有新发CRC。
结论
评估识别癌症的新策略需要一种结构化方法，包括对照人工记录审查进行验证
Zotero 插件