Mathematica Policy Research, Princeton, New Jersey, USA.
Mathematica Policy Research, Ann Arbor, Michigan, USA.
Health Serv Res. 2023 Oct;58(5):1131-1140. doi: 10.1111/1475-6773.14164. Epub 2023 May 12.
To develop a risk adjustment approach and test reliability and validity for oncology survival measures.
We used the National Cancer Institute's Surveillance, Epidemiology, and End Results (SEER)-Medicare data from 2010 to 2013, with mortality data through 2015.
We developed 2-year risk-standardized survival rates (RSSR) for melanoma, non-small cell lung cancer (NSCLC), and small cell lung cancer (SCLC). Patients were attributed to group practices based on the plurality of visits. We identified the risk-adjustment variables via bootstrap and calculated the RSSRs. Reliability was tested via three approaches: (1) signal-to-noise ratio (SNR) reliability, (2) split-half, and (3) test-retest using bootstrap. We tested known group validity by stage at diagnosis using Cohen's d.
DATA COLLECTION/EXTRACTION METHODS: We selected all patients enrolled in Medicare and linked to SEER during the measurement period with an incident first primary diagnosis of stage I-IV melanoma, NSCLC, or SCLC. We excluded patients with missing data on month and/or stage of diagnosis.
Results are based on patients with melanoma (n = 4344); NSCLC (n = 16,080); and SCLC (n = 2807) diagnosed between 2012 and 2013. The median (interquartile range) for the RSSRs at the group practice-level were 0.89 (0.83-0.87) for melanoma, 0.37 (0.30-0.43) for NSCLC, and 0.19 (0.11-0.25) for SCLC. C-statistics for the models ranged from 0.725 to 0.825. The reliability varied by approach with median SNR 0.20, 0.25, and 0.13; median test-retest 0.59, 0.57, and 0.56; median split-half reliability 0.21, 0.29, and 0.29 for melanoma, NSCLC, and SCLC, respectively. Cohen's d for stage I-IIIa and IIIb+ was 1.27, 0.86, 0.60 for melanoma, NSCLC, and SCLC, respectively.
Our results suggest that these cancer survival measures demonstrated adequate test-retest reliability and expected findings for the known-group validity analysis. If data limitations and feasibility challenges can be addressed, implementation of these quality measures may provide a survival metric used for oncology quality improvement efforts.
开发一种肿瘤生存测量的风险调整方法，并检验其可靠性和有效性。
我们使用了美国国家癌症研究所的监测、流行病学和最终结果（SEER）-医疗保险数据，时间范围为 2010 年至 2013 年，死亡数据截止到 2015 年。
我们为黑色素瘤、非小细胞肺癌（NSCLC）和小细胞肺癌（SCLC）开发了 2 年风险标准化生存率（RSSR）。根据就诊次数的多数情况，将患者归入集团实践。我们通过自举法确定了风险调整变量，并计算了 RSSR。通过三种方法测试了可靠性：（1）信噪比（SNR）可靠性，（2）半分割，（3）使用自举法的测试重测。我们使用 Cohen 的 d 检验了已知组有效性，根据诊断时的分期进行。
数据收集/提取方法：我们选择了在测量期间内所有入组 Medicare 并与 SEER 相关联的患者，这些患者首次诊断为 I-IV 期黑色素瘤、NSCLC 或 SCLC，且具有月和/或诊断阶段的缺失数据。
结果基于黑色素瘤（n=4344）、非小细胞肺癌（n=16080）和小细胞肺癌（n=2807）患者，这些患者在 2012 年至 2013 年间被诊断。在集团实践层面，RSSR 的中位数（四分位距）为黑色素瘤 0.89（0.83-0.87），非小细胞肺癌 0.37（0.30-0.43），小细胞肺癌 0.19（0.11-0.25）。模型的 C 统计量范围为 0.725 至 0.825。可靠性因方法而异，黑色素瘤、非小细胞肺癌和小细胞肺癌的中位数 SNR 分别为 0.20、0.25 和 0.13；中位数测试重测分别为 0.59、0.57 和 0.56；中位数半分割可靠性分别为 0.21、0.29 和 0.29。黑色素瘤、非小细胞肺癌和小细胞肺癌的 I-IIIa 期和 IIIb+期的 Cohen's d 分别为 1.27、0.86 和 0.60。
我们的结果表明，这些癌症生存测量方法表现出足够的测试重测可靠性和已知组有效性分析的预期结果。如果能够解决数据限制和可行性挑战，实施这些质量措施可能会提供一种用于肿瘤质量改进工作的生存指标。
