External validation of medicare claims for breast cancer chemotherapy compared with medical chart reviews
External validation of medicare claims for breast cancer chemotherapy compared with medical chart reviews
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DOI：
10.1097/01.mlr.0000196978.34283.a6
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发表时间：
2006-02-01
期刊：
影响因子：
3
通讯作者：
Zhang, D
中科院分区：
文献类型：
--
作者：
Du, XLL;Key, CR;Zhang, D
背景资料：虽然医疗保险索赔数据已越来越多地用于检查癌症化疗的模式和结果，其外部效度尚未得到很好的study.Objectives：我们试图验证医疗保险索赔化疗与医疗图表审查相比。我们完成了1228名妇女的医疗图表审查，这些妇女在1993年至1999年期间在新墨西哥州被诊断患有乳腺癌，年龄在65岁及以上，这些妇女与医疗保险索赔数据有关，实现了估计的灵敏度超过90%和0.05的precision.Results水平：在150名受试者确定的医疗保险索赔接受化疗6个月内的诊断，75%的医疗记录确认已接受化疗。在其余25%没有图表验证的病例中，（1）33例病例有7次或更多的化疗索赔，并且在医疗保险数据中也有特定的化疗药物，占根据医疗保险索赔接受化疗的所有病例的22%（33/150），（2）4例病例有1至6次化疗索赔，占所有要求化疗的病例的3%（4/150）。在1078名根据医疗保险索赔没有接受化疗的受试者中，超过99%的人通过图表审查得到证实。医疗保险索赔和图表审查之间观察到的协议化疗是94%，总体可靠性（Kappa）为0.69（95%置信区间= 0.63-0.76）。结论：确定为接受化疗的医疗保险索赔的情况下，97%有强有力的证据，只有3%有弱证据接受这种治疗。
Background: Although Medicare claims data have been increasingly used to examine the patterns and outcomes of cancer chemotherapy, their external validity has not been well studied.Objectives: We sought to validate Medicare claims for chemotherapy compared with medical chart reviews.Patients and Methods: We completed medical chart reviews for 1228 women who were diagnosed with breast cancer at age 65 and older between 1993 and 1999 in New Mexico that were linked with Medicare claims data, achieving an estimated sensitivity of more than 90% and a 0.05 level of precision.Results: Of the 150 subjects identified by Medicare claims as receiving chemotherapy within 6 months of diagnosis, 75% were confirmed by medical records as having received chemotherapy. Of the remaining 25% of cases without chart verification, (1) 33 cases had 7 or more claims for chemotherapy and also had specific chemotherapy drugs indicated in Medicare data, representing 22% (33/150) of all cases that received chemotherapy according to Medicare claims and (2) 4 cases had 1 to 6 claims for chemotherapy, representing 3% (4/150) of all cases with claims for chemotherapy. Of those 1078 subjects who did not receive chemotherapy according to Medicare claims, more than 99% were confirmed by chart reviews. Observed agreement on chemotherapy between Medicare claims and chart reviews was 94% and overall reliability (kappa) was 0.69 (95% confidence interval = 0.63-0.76).Conclusions: Of cases identified as receiving chemotherapy by Medicare claims, 97% had strong evidence and only 3% had weak evidence for receiving this therapy.