从韩国国家健康保险数据中提取门诊患者癌症分期和转移代码的可行性及在 ICD-11 中的表达能力：一项横断面研究

Feasibility of extracting cancer stage and metastasis codes from health insurance claims of outpatients and expressibility in ICD-11: a cross-sectional study using national health insurance data from South Korea.

机构信息

HIRA Research Institute, Health Insurance Review & Assessment Service (HIRA), Wonju-si, Republic of Korea.

Department of Preventive Medicine, Hanyang University, Seoul, Republic of Korea

出版信息

BMJ Open. 2024 Feb 24;14(2):e073952. doi: 10.1136/bmjopen-2023-073952.

DOI:10.1136/bmjopen-2023-073952

PMID:38401892

原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC10895217/

Abstract

OBJECTIVES

This study aimed to evaluate the incidence of health insurance claims recording the cancer stage and TNM codes representing tumor extension size (T), lymph node metastasis (N), and distant metastasis (M) for patients diagnosed with cancer and to determine whether this extracted data could be applied to the new ICD-11 codes.

DESIGN

A cross-sectional study design was used, with the units of analysis as individual outpatients. Two dependent variables were extraction feasibility of cancer stage and TNM metastasis information from each claim. Expressibility of the two variables in ICD-11 was descriptively analysed.

SETTING AND PARTICIPANTS

The study was conducted in South Korea and study participants were outpatients: lung cancer (LC) (46616), stomach cancer (SC) (50103) and colorectal cancer (CC) (54707). The data set consisted of the first health insurance claim of each patient visiting a hospital from 1 July to 31 December 2021.

RESULTS

The absolute extraction success rates for cancer stage based on claims with cancer stage was 33.3%. The rates for stage for LC, SC and CC were 30.1%, 35.5% and 34.0%, respectively. The rate for TNM was 11.0%. The relative extraction success rates for stage compared with that for CC (the reference group) were lower for patients with LC (adjusted OR (aOR), 0.803; 95% CI 0.782 to 0.825; p<0.0001) but higher for SC (aOR 1.073; 95% CI 1.046 to 1.101; p<0.0001). The rates of TNM compared that for CC were 40.7% lower for LC (aOR, 0.593; 95% CI 0.569 to 0.617; p<0.0001) and 43.0% lower for SC (aOR 0.570; 95% CI 0.548 to 0.593; p<0.0001). There were limits to expressibility in ICD-11 regarding the detailed cancer stage and TNM metastasis codes.

CONCLUSION

Extracting cancer stage and TNM codes from health insurance claims were feasible, but expressibility in ICD-11 codes was limited. WHO may need to create specific cancer stage and TNM extension codes for ICD-11 due to the absence of current rules in ICD-11.

摘要

目的

本研究旨在评估健康保险索赔记录癌症分期和代表肿瘤扩展大小（T）、淋巴结转移（N）和远处转移（M）的 TNM 代码的发生率，以及这些提取的数据是否可应用于新的 ICD-11 代码。

设计

本研究采用了横断面研究设计，分析单位为个体门诊患者。两个因变量是从每个索赔中提取癌症分期和 TNM 转移信息的可行性。ICD-11 中两个变量的表达能力进行了描述性分析。

地点和参与者

该研究在韩国进行，研究对象为门诊患者：肺癌（LC）（46616）、胃癌（SC）（50103）和结直肠癌（CC）（54707）。数据集由每位患者于 2021 年 7 月 1 日至 12 月 31 日首次到医院就诊的健康保险索赔组成。

结果

基于有癌症分期的索赔，癌症分期的绝对提取成功率为 33.3%。LC、SC 和 CC 的分期率分别为 30.1%、35.5%和 34.0%。TNM 为 11.0%。与 CC（参考组）相比，分期的相对提取成功率较低的是 LC 患者（调整后的 OR（aOR），0.803；95%CI 0.782 至 0.825；p<0.0001），但较高的是 SC 患者（aOR 1.073；95%CI 1.046 至 1.101；p<0.0001）。与 CC 相比，LC 的 TNM 比率低 40.7%（aOR，0.593；95%CI 0.569 至 0.617；p<0.0001），SC 的 TNM 比率低 43.0%（aOR，0.570；95%CI 0.548 至 0.593；p<0.0001）。ICD-11 中有关详细癌症分期和 TNM 转移代码的表达能力有限。由于 ICD-11 中目前没有规则，世界卫生组织（WHO）可能需要为 ICD-11 创建特定的癌症分期和 TNM 扩展代码。