Division of Pharmaceutical Evaluation and Policy, Department of Pharmacy Practice, College of Pharmacy, University of Arkansas for Medical Sciences, Little Rock, AR.
Division of Hematology and Oncology, Department of Internal Medicine, College of Medicine, University of Arkansas for Medical Sciences, Little Rock, AR.
JCO Clin Cancer Inform. 2023 Jan;7:e2200099. doi: 10.1200/CCI.22.00099.
Arkansas is one of only four known states that have linked All-Payer Claims Database (APCD) to state's cancer registry (Arkansas Cancer Registry [ACR]). We evaluated the reporting consistency of radiation therapy (RT) between the two sources.
Women age ≥ 18 years diagnosed in 2013-2017 with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery were identified. Patients must have continuous insurance coverage (any private plans, Medicaid, and Medicare) in the 13 months (month of diagnosis and 12 months after). Receipt of RT was identified independently from ACR and APCD. We calculated sensitivity, specificity, positive predictive value, and negative predictive value for receipt of RT coded by the registry compared with APCD billing claims as the gold standard. We assessed the degree of concordance between the data sources by Cohen's kappa statistics.
The final sample included 2,695 patients who were in both databases and satisfied our inclusion/exclusion criteria. Using APCD as the gold standard, there were high sensitivity (88.1%) and positive predictive value (87.7%) and moderate specificity (71.1%) and negative predictive value (71.8%). The overall agreement between the two sources was 83.0%, with a kappa statistic of 0.59 (95% CI, 0.56 to 0.63). Consistency measures varied by age, stage, and insurance type with Medicare fee-for-service coverage only having the best and private insurance only the worse consistency.
In patients with early-stage hormone receptor-positive breast cancer who received breast-conserving surgery, recording of RT receipt was moderately consistent between Arkansas APCD and ACR. Future studies are needed to identify factors affecting reporting consistency to better use this unique resource in addressing population health problems.
阿肯色州是已知的四个将全支付者索赔数据库（APCD）与该州癌症登记处（阿肯色癌症登记处[ACR]）相连接的州之一。我们评估了这两个来源之间放射治疗（RT）报告的一致性。
在 2013-2017 年间，确定了患有早期激素受体阳性乳腺癌且年龄≥18 岁的女性患者。患者必须在诊断后的 13 个月（诊断当月和 12 个月后）内拥有连续的保险覆盖（任何私人计划、医疗补助和医疗保险）。从 ACR 和 APCD 独立确定 RT 的接受情况。我们计算了与 APCD 计费索赔相比，登记处编码的 RT 接受情况的敏感性、特异性、阳性预测值和阴性预测值作为金标准。我们通过 Cohen's kappa 统计数据评估了数据源之间的一致性程度。
最终样本包括 2695 名同时存在于两个数据库中且符合我们纳入/排除标准的患者。使用 APCD 作为金标准，RT 接受的敏感性（88.1%）和阳性预测值（87.7%）较高，特异性（71.1%）和阴性预测值（71.8%）适中。两个来源之间的总体一致性为 83.0%，kappa 统计值为 0.59（95%CI，0.56 至 0.63）。一致性测量值因年龄、分期和保险类型而异，医疗保险按服务收费覆盖的一致性最好，而私人保险的一致性最差。
在接受保乳手术的早期激素受体阳性乳腺癌患者中，阿肯色州 APCD 和 ACR 之间 RT 接受情况的记录存在中度一致性。需要进一步研究以确定影响报告一致性的因素，以便更好地利用这一独特资源来解决人口健康问题。
