Breast cancer treatment across health care systems: linking electronic medical records and state registry data to enable outcomes research.
Breast cancer treatment across health care systems: linking electronic medical records and state registry data to enable outcomes research.
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DOI：
10.1002/cncr.28395
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发表时间：
2014-01-01
期刊：
影响因子：
6.2
通讯作者：
Das, Amar K.
中科院分区：
文献类型：
--
作者：
Kurian, Allison W.;Mitani, Aya;Desai, Manisha;Yu, Peter P.;Seto, Tina;Weber, Susan C.;Olson, Cliff;Kenkare, Pragati;Gomez, Scarlett L.;de Bruin, Monique A.;Horst, Kathleen;Belkora, Jeffrey;May, Suepattra G.;Frosch, Dominick L.;Blayney, Douglas W.;Luft, Harold S.;Das, Amar K.
关键词：
对癌症结果的理解受到数据碎片的限制。我们分析了通过整合来自三个来源的乳腺癌数据所产生的信息：两个医疗保健系统的电子医疗记录(EMR)和州登记。我们从2000年至2010年在加州两个独立机构接受治疗的所有乳腺癌患者的急诊磁共振中提取了诊断测试和治疗数据：社区诊所(Palo Alto Medical Foundation)和学术医疗中心(Stanford University)。我们纳入了基于人口的加州癌症登记中心(CCR)的记录，然后将社区和大学患者的EMR-CCR数据集联系起来。我们最初确定了8210名大学患者和5770名社区患者；相关数据集显示16%的患者重叠，产生12,109名独特的患者。在这两个机构接受治疗的所有社区患者，而不是大学患者的比例随着癌症预后因素的恶化而增加。在连接数据集之前，社区患者接受的干预似乎比大学患者少(乳房切除术：37.6%比43.2%；化疗：35%比41.7%；磁共振成像：10%比29.3%；基因检测：2.5%比9.2%)。相关社区和大学的数据显示，在这两个机构接受治疗的患者都得到了更多的干预(乳房切除：55.8%；化疗：47.2%；核磁共振：38.9%；基因检测：10.9%；P<；每个三方机构比较为0.001)。数据关联发现，16%的患者在两个医疗系统中接受了治疗，尽管有类似的预后因素，但他们接受了比其他人更密集的治疗。通过整合来自急诊室和基于人群的登记的补充数据，我们对乳腺癌护理和推动治疗利用的因素有了更全面的了解。
Understanding of cancer outcomes is limited by data fragmentation. We analyzed the information yielded by integrating breast cancer data from three sources: electronic medical records (EMRs) of two healthcare systems and the state registry. We extracted diagnostic test and treatment data from EMRs of all breast cancer patients treated from 2000–2010 in two independent California institutions: a community-based practice (Palo Alto Medical Foundation) and an academic medical center (Stanford University). We incorporated records from the population-based California Cancer Registry (CCR), and then linked EMR-CCR datasets of Community and University patients. We initially identified 8210 University patients and 5770 Community patients; linked datasets revealed a 16% patient overlap, yielding 12,109 unique patients. The proportion of all Community patients, but not University patients, treated at both institutions increased with worsening cancer prognostic factors. Before linking datasets, Community patients appeared to receive less intervention than University patients (mastectomy: 37.6% versus 43.2%; chemotherapy: 35% versus 41.7%; magnetic resonance imaging (MRI): 10% versus 29.3%; genetic testing: 2.5% versus 9.2%). Linked Community and University datasets revealed that patients treated at both institutions received substantially more intervention (mastectomy: 55.8%; chemotherapy: 47.2%; MRI: 38.9%; genetic testing: 10.9%; p<0.001 for each three-way institutional comparison). Data linkage identified 16% of patients who were treated in two healthcare systems and who, despite comparable prognostic factors, received far more intensive treatment than others. By integrating complementary data from EMRs and population-based registries, we obtained a more comprehensive understanding of breast cancer care and factors that drive treatment utilization.
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影响因子：
6.2
作者：
Hwang, E. Shelley;Lichtensztajn, Daphne Y.;Gomez, Scarlett Lin;Fowble, Barbara;Clarke, Christina A.
通讯作者：
Clarke, Christina A.
影响因子：
120.7
作者：
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通讯作者：
Yancy, Clyde
影响因子：
3
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Bickell, Nina A.;McAlearney, Ann Scheck;Franco, Rebeca
通讯作者：
Franco, Rebeca
影响因子：
45.3
作者：
Guadagnolo, B. Ashleigh;Liao, Kai-Ping;Shih, Ya-Chen Tina
通讯作者：
Shih, Ya-Chen Tina
影响因子：
45.3
作者：
Hershman, Dawn L.;Kushi, Lawrence H.;Neugut, Alfred I.
通讯作者：
Neugut, Alfred I.