Ability of Medicaid claims data to identify incident cases of breast cancer in the Ohio Medicaid population
Ability of Medicaid claims data to identify incident cases of breast cancer in the Ohio Medicaid population
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DOI：
10.1111/1475-6773.00155
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发表时间：
2003-06-01
影响因子：
3.4
通讯作者：
Rimm, AA
中科院分区：
文献类型：
--
作者：
Koroukian, SM;Cooper, GS;Rimm, AA
背景。使用医疗补助数据来研究癌症相关的结果是非常可取的。然而，医疗补助报销数据在确定乳腺癌病例方面的准确性尚不清楚。(1)评估医疗补助报销数据对乳腺癌病例确定的敏感性；(2)使用俄亥俄州癌症发病率监测系统（OCISS）作为金标准，确定从医疗补助索赔中检索的诊断和程序代码的阳性预测值（PPV）。该研究使用了1997 - 1998年OCISS和医疗补助登记档案（n = 1,648）。索赔搜索产生了2635起事件，其中1132起也通过OCISS-Medicaid档案确定。在人群亚组中计算医疗补助数据的敏感性和PPV。总体敏感度为68.7%，但在人群的各个亚组之间差异很大。仅在研究年度的部分时间参加医疗补助计划的妇女比在研究年度的12个月参加医疗补助计划的妇女低（分别为56.7%和78.0%,p < 0.0001），符合医疗保险和医疗补助双重资格的妇女比不参加医疗保险计划的妇女低（分别为63.1%和78.6%,p < 0.0001）。总体PPV为43.0%，在进行乳房切除术和乳房肿瘤切除术以及乳腺癌诊断的情况下，PPV增加到86.6%。医疗补助要求对乳腺癌病例确定的敏感性有些低，但当考虑到整个研究年度期间参加医疗补助的妇女时，敏感性大大提高。由于假阳性率高，PPV很差。除了诊断代码外，在程序代码存在的情况下获得的较高PPV将有助于研究人员使用医疗补助索赔数据正确识别乳腺癌事件病例。
Background. The use of Medicaid data to study cancer-related outcomes would be highly desirable. However, the accuracy of Medicaid claims data in the identification of incident cases of breast cancer is unknown.Objectives. (1) To estimate the sensitivity of Medicaid claims data for case ascertainment of breast cancer; and (2) to determine the positive predictive value (PPV) of diagnostic and procedure codes retrieved from Medicaid claims, using the Ohio Cancer Incidence Surveillance System (OCISS) as the gold standard.Methods. The study used the linked OCISS and Medicaid enrollment files, 19971998 (n = 1,648). The claims search yielded 2,635 incident cases, of which 1,132 were also identified through the OCISS-Medicaid files. Sensitivity and PPV of Medicaid data were calculated in subgroups of the population.Results. The overall sensitivity was 68.7 percent, but varied greatly across the subgroups of the population. It was lower among women enrolled in Medicaid only for part of the study year than those enrolled in Medicaid for 12 months of the study year (56.7 percent and 78.0 percent respectively, p < 0.0001), and lower among those who are dual Medicare-Medicaid eligible compared to those not participating in the Medicare program (63.1 percent and 78.6 percent respectively, p < 0.0001). The overall PPV was 43.0 percent, increasing up to 86.6 percent in the presence of procedure codes indicating the presence of mastectomy and lumpectomy, in addition to that of breast cancer diagnosis.Conclusions. The sensitivity of Medicaid claims for case ascertainment of breast cancer is somewhat low, but improves considerably when accounting for women enrolled in Medicaid for the entire duration of the study year. The PPV is poor due to a high rate of false positives. The higher PPV obtained in the presence of procedure codes, in addition to diagnosis codes, will help researchers to correctly identify incident cases of breast cancer using Medicaid claims data.