Sensitivity of Medicare claims data for measuring use of standard multiagent chemotherapy regimens.
Sensitivity of Medicare claims data for measuring use of standard multiagent chemotherapy regimens.
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DOI：
10.1097/mlr.0b013e31824e342f
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发表时间：
2014-03
期刊：
影响因子：
3
通讯作者：
Lan L
中科院分区：
文献类型：
--
作者：
Lamont EB;Lan L
我们试图确定医疗保险账单数据记录老年医疗保险癌症患者接受常见多药化疗方案的准确性。我们将406名老年癌症患者的金标准临床试验数据与来自医疗保险和医疗补助服务中心（CMS）的医疗保险索赔数据合并，这些患者已知接受了六项癌症和白血病组B（CALGB）乳腺癌、结肠直肠癌和肺癌试验（试验编号：9344、9730、9235、9732、80203、89803）中的一项治疗。将CMS化疗代码与金标准CALGB治疗数据进行比较，我们估计了医疗保险数据在测量每种多药化疗方案的正确药物和时间表方面的敏感性。总体而言，92%（375/406）的CALGB患者有同期CMS声明，表明接受了化疗。CMS门诊索赔记录使用正确药物和正确时间表（即，所有药物必须在同一天开具账单）的比例为78%（275/354）。所有治疗方案的敏感性相似：卡铂和紫杉醇83%，5 FU和亚叶酸80%，FOLFIRI 76%，阿霉素和环磷酰胺75%，顺铂和依托泊苷75%。我们通过应用编码算法确定了至少四分之三的老年医疗保险癌症患者在门诊环境中接受标准一线多药化疗方案的临床试验。该算法可能是有用的，在确定队列的老年医疗保险患者的观察性研究的比较有效的标准多药化疗方案。
We sought to determine the accuracy with which Medicare billing data documents elderly Medicare cancer patients’ receipt of common multi-agent chemotherapy regimens. We merged gold-standard clinical trial data from 406 elderly cancer patients known to be treated on one of six Cancer and Leukemia Group B (CALGB) breast, colorectal, and lung cancer trials (trial numbers; 9344, 9730, 9235,9732, 80203, 89803) with their Medicare claims data from Centers for Medicare and Medicaid Services (CMS). Comparing CMS chemotherapy codes to gold-standard CALGB treatment data, we estimated Medicare data’s sensitivity at measuring the correct drugs and schedule for each of the multi-agent chemotherapy regimens. Overall 92% (375/406) of CALGB patients had contemporaneous CMS claims indicating receipt of chemotherapy. The overall sensitivity of CMS ambulatory claims for documenting treatment with the correct drugs and on the correct schedule (i.e., all drugs had to be billed on the same day) for the five common multi-agent chemotherapy regimens was 78% (275/354) for those potentially treated in the ambulatory setting. The sensitivity was similar for all treatment regimens: carboplatin and paclitaxel 83%, 5FU and leucovorin 80%, FOLFIRI 76%, doxorubicin and cyclophosphamide 75%, and cisplatin and etoposide 75%. We identified at least three-quarters of elderly Medicare cancer patients treated on a clinical trial with standard first-line multi-agent chemotherapy regimens in the ambulatory setting by applying coding algorithms. The algorithms may be useful in identifying cohorts of elderly Medicare patients for observational studies of the comparative effectiveness of standard multi-agent chemotherapy regimens.