Validating billing/encounter codes as indicators of lung, colorectal, breast, and prostate cancer recurrence using 2 large contemporary cohorts.
Validating billing/encounter codes as indicators of lung, colorectal, breast, and prostate cancer recurrence using 2 large contemporary cohorts.
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DOI：
10.1097/mlr.0b013e318277eb6f
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发表时间：
2014-10
期刊：
影响因子：
3
通讯作者：
Weeks JC
中科院分区：
文献类型：
--
作者：
Hassett MJ;Ritzwoller DP;Taback N;Carroll N;Cronin AM;Ting GV;Schrag D;Warren JL;Hornbrook MC;Weeks JC
相当大比例的癌症相关死亡率是由于复发，而不是新发转移性疾病，但我们对这些患者的了解相对较少。为了填补这一空白，研究人员经常使用继发性恶性肿瘤或化疗的管理代码来识别基于人群的数据集中的复发病例。然而，这些算法尚未在大型、当代、常规护理队列中得到验证。评价继发性恶性肿瘤和化疗编码作为I-III期肺癌、结直肠癌、乳腺癌和前列腺癌确定性局部治疗后复发指标的有效性。我们使用两个与金标准复发状态信息相关的管理数据集：CanCORS/Medicare（诊断2003-2005）和HMO/癌症研究网络（诊断2000-2005），在诊断后14个月和60个月评估这些代码的敏感性，特异性和阳性预测值（PPV）。我们确定了929名CanCORS/Medicare患者和5298名HMO/CRN患者。灵敏度、特异性和PPV范围很广，取决于包括哪些代码和癌症类型。对于肺癌、结直肠癌和乳腺癌患者，继发性恶性肿瘤和化疗编码的组合是最敏感的（75%-85%）;没有一个编码集是高度敏感和高度特异的。对于前列腺癌，没有任何代码集能够提供中等灵敏度（≤19%）。继发性恶性肿瘤和化疗代码不能识别复发性癌症，而没有一些错误分类的风险。基于现有算法的结果应谨慎解释。需要做更多的工作来开发一种有效的算法，用于描述结果并定义比较有效性研究的患者队列。
A substantial proportion of cancer-related mortality is attributable to recurrent, not de novo metastatic disease, yet we know relatively little about these patients. To fill this gap, investigators often use administrative codes for secondary malignant neoplasm or chemotherapy to identify recurrent cases in population-based datasets. However, these algorithms have not been validated in large, contemporary, routine care cohorts. To evaluate the validity of secondary malignant neoplasm and chemotherapy codes as indicators of recurrence after definitive local therapy for stage I-III lung, colorectal, breast, and prostate cancer. We assessed the sensitivity, specificity, and positive predictive value (PPV) of these codes 14- and 60-months after diagnosis using two administrative datasets linked with gold-standard recurrence status information: CanCORS/Medicare (diagnoses 2003-2005) and HMO/Cancer Research Network (diagnoses 2000-2005). We identified 929 CanCORS/Medicare patients and 5298 HMO/CRN patients. Sensitivity, specificity, and PPV ranged widely depending on which codes were included and the type of cancer. For patients with lung, colorectal, and breast cancer, the combination of secondary malignant neoplasm and chemotherapy codes was the most sensitive (75%-85%); no code-set was highly sensitive and highly specific. For prostate cancer, no code-set offered even moderate sensitivity (≤19%). Secondary malignant neoplasm and chemotherapy codes could not identify recurrent cancer without some risk of misclassification. Findings based on existing algorithms should be interpreted with caution. More work is needed to develop a valid algorithm that can be used to characterize outcomes and define patient cohorts for comparative effectiveness research studies.