Using Medicare data to estimate the prevalence of breast cancer screening in older women: Comparison of different methods to identify screening mammograms
Using Medicare data to estimate the prevalence of breast cancer screening in older women: Comparison of different methods to identify screening mammograms
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DOI：
10.1111/1475-6773.10912
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发表时间：
2002-12-01
影响因子：
3.4
通讯作者：
Freeman, JL
中科院分区：
文献类型：
--
作者：
Randolph, WM;Mahnken, JD;Freeman, JL
目标.比较不同的方法来定义筛查乳房X线照片与医疗保险索赔及其对估计乳腺癌筛查率的影响。对1993年61 962名妇女和1998年59 652名妇女的医疗保健门诊设施和医生报销进行了审查，以寻找接受乳房X光检查的证据。我们比较了来自CPT（当前程序术语）代码的筛查性乳房X线摄影使用的估计值，以将乳房X线摄影分类为筛查或诊断与使用CPT代码加上前两年乳房相关诊断的算法进行比较。我们还比较了从单独的医生索赔，单独的设施索赔，或两种索赔来源的组合审查获得的估计。单独使用医生索赔产生的筛查率估计值与使用医生和门诊（设施）索赔计算的筛查率相似。1993年，CPT乳腺X线筛查代码低估了筛查率，而使用算法得出的估计值为8.3%对18.0%，p < 0.001。到1998年，使用CPT代码进行筛查乳房X线摄影产生的筛查患病率更接近算法产生的比率（23.0%对25.1%）。通过各种方法估计筛查性乳腺X线摄影与医疗保险索赔，其患病率在1993年和1998年之间大幅增加。在20世纪90年代，提供者在向医疗保险收费时增加了对乳房X光检查筛查代码的使用。这提高了索赔者区分筛查和诊断性乳房X光检查的能力，但用索赔计算的筛查率继续低于一般老年妇女自我报告使用乳房X光检查的筛查率。
Objectives. To compare different methods for defining screening mammograms with Medicare claims and their impact on estimates of breast cancer screening rates.Methods. Medicare outpatient facility and physician claims for 61,962 women in 1993 and 59,652 women in 1998 were reviewed for evidence of receipt of screening mammography. We compared the estimates of screening mammography use derived from CPT (Current Procedure Terminology) codes to categorize mammograms as screening or diagnostic versus using an algorithm that uses CPT codes plus breast-related diagnoses in the prior two years. We also compared estimates obtained from review of physician claims alone, facility claims alone, or the combination of the two sources of claims.Results. Use of physician claims alone produced estimates of screening rates similar to rates calculated from use of both physician and outpatient (facility) claims. In 1993, the CPT code for screening mammography underestimated the rate of screening compared to estimates generated by using the algorithm (8.3 percent versus 18.0 percent prevalence, p < 0.001). By 1998, the screening prevalence rate generated from using the CPT code for screening mammography more closely approximated the rate generated by the algorithm (23.0 percent versus 25.1 percent). By all methods of estimating screening mammography with Medicare claims, its prevalence increased substantially between 1993 and 1998.Conclusion. Providers increased their use of the screening mammography code in their charges to Medicare during the 1990s. This has improved the claims' ability to distinguish screening from diagnostic mammograms, but screening rates computed with claims continue to fall below those generated from self-reports of mammography use among general populations of older women.