External validation of a claims-based algorithm for classifying kidney-cancer surgeries
External validation of a claims-based algorithm for classifying kidney-cancer surgeries
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DOI：
10.1186/1472-6963-9-92
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发表时间：
2009-06-06
影响因子：
2.8
通讯作者：
Litwin, Mark S.
中科院分区：
文献类型：
--
作者：
Miller, David C.;Saigal, Christopher S.;Litwin, Mark S.
背景：与其他恶性肿瘤不同，没有文献支持用于确定肾癌患者手术治疗的医疗索赔数据的准确性。我们试图在外部验证之前发布的基于医疗保险索赔的算法，用于对早期肾癌患者的手术治疗进行分类。为了实现这一目标，我们将基于 Medicare 索赔的手术分配与 SEER 登记数据和临床手术报告中指定的手术类型进行了比较。方法：使用链接的 SEER-Medicare 数据，我们计算了 Medicare 索赔和 SEER 数据之间的一致性，以识别 6,515 名诊断为早期肾癌的患者的癌症定向手术。接下来，对于 120 个案例的子集，我们确定了索赔算法与医疗记录之间的一致性。最后，使用病历作为参考标准，我们计算了索赔算法的敏感性、特异性以及阳性和阴性预测值。结果：在 6,515 例病例中，医疗保险索赔和 SEER 数据分别确定了 5,483 (84.1%) 和 5,774 (88.6%) 名患者接受了癌症定向手术（观察一致性 = 93%，kappa = 0.69，95% CI 0.66-0.71）。两个数据源显示部分肾切除术与根治性肾切除术分类的一致性为 97%（kappa = 0.83，95% CI 0.81-0.86）。我们观察到索赔算法与临床手术报告之间的一致性达到 97%；对于肾部分切除术和腹腔镜手术的识别，索赔算法的阳性预测值超过 90%。 结论：医疗保险索赔是确定早期肾癌患者基于人群的手术护理模式的准确数据来源。
Background: Unlike other malignancies, there is no literature supporting the accuracy of medical claims data for identifying surgical treatments among patients with kidney cancer. We sought to validate externally a previously published Medicare-claims-based algorithm for classifying surgical treatments among patients with early-stage kidney cancer. To achieve this aim, we compared procedure assignments based on Medicare claims with the type of surgery specified in SEER registry data and clinical operative reports.Methods: Using linked SEER-Medicare data, we calculated the agreement between Medicare claims and SEER data for identification of cancer-directed surgery among 6,515 patients diagnosed with early-stage kidney cancer. Next, for a subset of 120 cases, we determined the agreement between the claims algorithm and the medical record. Finally, using the medical record as the reference-standard, we calculated the sensitivity, specificity, and positive and negative predictive values of the claims algorithm.Results: Among 6,515 cases, Medicare claims and SEER data identified 5,483 (84.1%) and 5,774 (88.6%) patients, respectively, who underwent cancer-directed surgery (observed agreement = 93%, kappa = 0.69, 95% CI 0.66-0.71). The two data sources demonstrated 97% agreement for classification of partial versus radical nephrectomy (kappa = 0.83, 95% CI 0.81-0.86). We observed 97% agreement between the claims algorithm and clinical operative reports; the positive predictive value of the claims algorithm exceeded 90% for identification of both partial nephrectomy and laparoscopic surgery.Conclusion: Medicare claims represent an accurate data source for ascertainment of population-based patterns of surgical care among patients with early-stage kidney cancer.