DATA SOURCES AND PATTERNS OF CARE FOR BREAST CANCER

本申请是10月1日提交的申请（CA/HS 75545）的修订版， 1996年，国家癌症研究所响应其计划 公告PA-95 - 069，使用基于健康索赔的癌症监测 数据系统。 研究使用了行政数据集，医院 出院数据和/或癌症登记数据，以研究地理 乳腺癌护理模式的变化，以及研究 患者和医院特征与 护理和死亡率。在他们的研究结果中，他们报告说， 保乳手术在全国各地各不相同， 预期 他们还报告说，一些妇女（例如，老年妇女） 和生活在农村地区的妇女）比其他人更不可能 接受标准治疗。 根据他们的发现，几位作者 表明与以下因素相关的随机临床试验的结果 乳腺癌治疗和传播实践指南， 国家卫生研究院等国家组织 在美国没有影响乳腺癌的治疗。 如果他们的 结论是无效的，但是，任何响应活动可能 被误导了 不仅浪费了资源， 这些研究可能会引起妇女不必要的焦虑和困惑 乳腺癌的治疗和他们的供应商。我们已经构建 两个主要数据集包括来自医疗记录，患者， 和医生-一个数据集来自马萨诸塞州（N = 1，497）， 另一个来自明尼苏达州（N-2，327）。 我们建议使用这些数据， 评估二手数据的准确性。 本研究的具体目的 是1）构建早期乳腺癌患者队列， 使用医疗保险索赔数据、出院数据、肿瘤登记数据 数据并比较样本量、临床特征和 人口统计学特征，结果与那些获得的主要 数据; 2）确定报告的护理模式的程度 二次数据与从一次数据中获得的模式一致 （3）判断是否存在一致性 二次数据和一次数据的特征不同， 患者或提供者类型;以及4）开发算法以调整 估计数来自二级数据集。

This application is a revision of one (CA/HS75545) submitted October 1, 1996 to the National Cancer Institute in response to their Program Announcement PA-95-069, Cancer Surveillance Using Health Claim-Based Data Systems. Researches have used administrative data sets, hospital discharge data, and/or cancer registry data to study geographic variation in patterns of care for breast cancer as well as to study the association of patient and hospital characteristics with patterns of care and mortality. Among their findings, they reported that rates of breast-conserving surgery varied across the country and were lower than expected. They also reported that some women (for example, older women and women who lived in rural areas) were less likely than others to receive standard treatments. Based on their findings, several authors suggested that the results of randomized clinical trials associated with breast cancer treatment and the dissemination of practice guidelines by national organizations such as the National Institutes of Health have not influenced breast cancer care in the United States. If their conclusions are not valid, however, any activities taken in response may be misguided. Resources would not only be wasted, but the results of these studies may cause unnecessary anxiety and confusion among women treated for breast cancer and among their providers. We have constructed two primary data sets comprised of data from medical records, patients, and physicians - one data set is from Massachusetts (N=1,497) and the other is from Minnesota (N-2,327). We propose to use these data to assess the accuracy of secondary data. The specific aims of this study are to 1) construct cohorts of patients with early-stage breast cancer using Medicare claims data, hospital discharge data, ad tumor registry data and compare the sample size, clinical characteristics, and demographic characteristics that result with those obtained from primary data; 2) determine the extent to which patterns of care reported from secondary data are consistent with patterns obtained from primary sources; 3) determine whether the degree of consistency between secondary data and primary data varies by the characteristics of patients or type of provider; and 4) develop an algorithm to adjust estimates derived from secondary data sets.