National Cancer Institute, Division of Cancer Control and Population Science, Healthcare Delivery Program, Bethesda, MD.
Information Management Services, Calverton, MD.
J Natl Cancer Inst Monogr. 2020 May 1;2020(55):66-71. doi: 10.1093/jncimonographs/lgz031.
Physicians are vital to health-care delivery, but assessing their impact on care can be challenging given limited data. Historically, health services researchers have obtained physician characteristics data from the American Medical Association (AMA) Physician Masterfile. The Center for Medicare and Medicaid Services' Medicare Data on Provider Practice and Specialty (MD-PPAS) file was assessed, as an alternative source of physician data, particularly in the context of cancer health services research.
We used physician National Provider Identifiers in the MD-PPAS data (2008-2014) to identify physicians in the AMA data current as of July 18, 2016. Within each source, we grouped physicians into six broad specialty groups. Percent agreement and Cohen's kappa coefficient (k) were calculated for age, sex, specialty, and practice state.
Among the 698 202 included physicians, there was excellent agreement for age (percent agreement = 97.7%, k = 0.97) and sex (99.4%, k = 0.99) and good agreement for specialty (86.1%, k = 0.80). Within specialty, using AMA as the reference, agreement was lowest for oncologists (77%). Approximately 85.9% of physicians reported the same practice state in both data sets.
Although AMA data have been commonly used to account for physician-level factors in health services research, MD-PPAS data provide researchers with an alternative option depending on study needs. MD-PPAS data may be optimal if nonphysicians, provider utilization, practice characteristics, and/or temporal changes are of interest. In contrast, the AMA data may be optimal if more granular specialty, physician training, and/or a broader inclusion of physicians is of interest.
医生对于医疗保健的提供至关重要,但由于数据有限,评估他们对护理的影响具有挑战性。从历史上看,卫生服务研究人员从美国医学协会(AMA)医师主文件中获取医师特征数据。评估了医疗保险和医疗补助服务中心的医疗保险提供者实践和专业数据(MD-PPAS)文件,作为医师数据的替代来源,特别是在癌症卫生服务研究方面。
我们使用 MD-PPAS 数据中的医师国家提供者标识符(2008-2014 年)来识别截至 2016 年 7 月 18 日 AMA 数据中的医师。在每个来源中,我们将医师分为六个广泛的专业组。计算了每个来源中年龄、性别、专业和实践状态的百分比一致性和 Cohen's kappa 系数(k)。
在纳入的 698202 名医师中,年龄(百分比一致性=97.7%,k=0.97)和性别(99.4%,k=0.99)的一致性非常好,专业的一致性也很好(86.1%,k=0.80)。在专业范围内,以 AMA 为参考,肿瘤学家的一致性最低(77%)。大约 85.9%的医师在两个数据集报告了相同的实践状态。
尽管 AMA 数据通常用于在卫生服务研究中考虑医师水平因素,但 MD-PPAS 数据为研究人员提供了另一种选择,具体取决于研究需求。如果研究目的是非医师、提供者利用、实践特征和/或时间变化,则 MD-PPAS 数据可能是最佳选择。相比之下,如果研究目的是更细粒度的专业、医师培训和/或更广泛的医师纳入,则 AMA 数据可能是最佳选择。