Bradley Cathy J, Liang Rifei, Jasem Jagar, Lindrooth Richard C, Sabik Lindsay M, Perraillon Marcelo C
University of Colorado Cancer Center, Aurora, CO, USA.
Colorado School of Public Health, Aurora, CO, USA.
Cancer Inform. 2022 Jul 30;21:11769351221112457. doi: 10.1177/11769351221112457. eCollection 2022.
We evaluated treatment concordance between the Colorado All Payer Claims Database (APCD) and the Colorado Central Cancer Registry (CCCR) to explore whether APCDs can augment registry data. We compare treatment concordance for breast cancer, an extensively studied site with an inpatient reporting source and select leukemias that are often diagnosed outpatient.
We analyzed concordance by cancer type and treatment, patient demographics, reporting source, and health insurance, calculating the sensitivity, specificity, positive predictive values (PPV) and Kappa statistics. We estimated an adjusted logistic regression model to assess whether the APCD statistically significantly reports additional cancer-directed treatments.
Among women with breast cancer, 14% had chemotherapy treatments that were absent from the CCCR. Missing treatments were more common among women younger than age 50 (15%) and patients aged 75 and older (19%), rural residents (17%), and when the reporting source was outpatient (22%). Similar and more pronounced patterns for people with leukemia were observed. Concordance for oral treatments was lower for each cancer. Sensitivity and PPVs were high, with moderate Kappa statistics. The APCD was 5.3 percentage points less likely to identify additional treatments for breast cancer patients and 10 percentage points more likely to identify additional treatments when the reporting source was an outpatient facility.
A robust data infrastructure is needed to investigate research questions that require population-level analyses, particularly for questions seeking to reduce health inequity and comparisons across payers, including Medicare Advantage and fee-for-service. APCD data are a step toward creating an infrastructure for cancer, particularly for patients who reside in rural areas and/or receive care from outpatient centers.
我们评估了科罗拉多州全支付方索赔数据库（APCD）与科罗拉多州中央癌症登记处（CCCR）之间的治疗一致性，以探讨APCD是否可以扩充登记处数据。我们比较了乳腺癌（一个有住院报告来源且经过广泛研究的部位）以及通常在门诊诊断的特定白血病的治疗一致性。
我们按癌症类型、治疗方式、患者人口统计学特征、报告来源和医疗保险分析一致性，计算敏感性、特异性、阳性预测值（PPV）和卡帕统计量。我们估计了一个调整后的逻辑回归模型，以评估APCD是否在统计学上显著报告了额外的癌症定向治疗。
在乳腺癌女性患者中，14%接受的化疗治疗在CCCR中未记录。缺失的治疗在50岁以下女性（15%）、75岁及以上患者（19%）、农村居民（17%）以及报告来源为门诊时（22%）更为常见。白血病患者也观察到了类似且更明显的模式。每种癌症的口服治疗一致性较低。敏感性和PPV较高，卡帕统计量中等。APCD识别乳腺癌患者额外治疗的可能性低5.3个百分点，而当报告来源为门诊机构时，识别额外治疗的可能性高10个百分点。
需要强大的数据基础设施来研究需要进行人群水平分析的研究问题，特别是对于旨在减少健康不平等以及跨支付方（包括医疗保险优势计划和按服务收费）进行比较的问题。APCD数据是朝着建立癌症基础设施迈出的一步，特别是对于居住在农村地区和/或从门诊中心接受治疗的患者。
