Cancer Care in the United States: Identifying End-of-Life Cohorts
Cancer Care in the United States: Identifying End-of-Life Cohorts
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DOI：
10.1089/jpm.2008.0239
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发表时间：
2009-02-01
影响因子：
2.8
通讯作者：
Goodman, David C.
中科院分区：
文献类型：
--
作者：
Berke, Ethan M.;Smith, Tenbroeck;Goodman, David C.
目的：临终关怀越来越被认为是许多患者癌症管理的重要组成部分。目前衡量临终关怀的方法由于难以用行政数据确定癌症队列而受到限制。我们研究了几种识别临终癌症队列的技术，这些技术的索赔数据是基于人群的，地理上可扩展的，并且易于常规更新。方法：使用65岁及以上患者的医疗保险索赔，比较四种识别临终癌症队列的技术；一个基于A部分的数据，使用广泛的原发性或狭窄的继发性癌症诊断，两个基于B部分的数据，一个结合了A部分和B部分的方法。我们测试了每个定义的性能，以确定适当的临终癌症人群。结果：在死亡前180天的窗口内使用原发性或继发性癌症诊断的A部分和B部分联合定义在确定生命末期队列时似乎是最准确和最具包容性的（78.7%）。结论：结合住院和门诊索赔数据，并根据广泛的原发性或狭窄的继发性癌症定义识别病例，是确定临终队列最准确和最具包容性的方法。
Objectives: End-of-life care is increasingly recognized as an important part of cancer management for many patients. Current methods to measure end-of-life care are limited by difficulties in identifying cancer cohorts with administrative data. We examined several techniques of identifying end-of-life cancer cohorts with claims data that is population-based, geographically scalable, and amenable to routine updating.Methods: Using Medicare claims for patients 65 years of age and older, four techniques for identifying end-of-life cancer cohorts were compared; one based on Part A data using a broad primary or narrow secondary diagnosis of cancer, two based on Part B data, and one combining the Part A and B methods. We tested the performance of each definition to ascertain an appropriate end-of-life cancer population.Results: The combined Part A and B definition using a primary or secondary diagnosis of cancer within a window of 180 days prior to death appears to be the most accurate and inclusive in ascertaining an end-of-life cohort (78.7% attainment).Conclusion: Combining inpatient and outpatient claims data, and identifying cases based upon a broad primary or a narrow secondary cancer definition is the most accurate and inclusive in ascertaining an end-of-life cohort.