Do Medicare Claims Measure Chemotherapy Use and Outcomes

描述(由申请人提供)：尽管他们提供了超过一半的 所有美国癌症患者，老年人在临床上的代表性都很低 寻求确定化疗疗效和毒性的试验。为了这个 原因是，临床试验的结果可能不适用于一般 老年癌症患者群体。尽管如此，内科医生需要临床 有关化疗的风险和益处的信息 一大批患者。我是一名内科肿瘤学家，致力于 在肿瘤学和卫生服务研究的十字路口 重点是确定化疗的总体风险和好处 老年癌症患者群体。五年后，我希望能够 进行一系列流行病学研究，以检验可能的贡献 医学共病对老年人化疗利用及预后的影响 美国癌症患者。这一长期研究议程需要额外的 我的培训和三项初步研究，以确定 候选数据源，Heath Care Finding Administration的Medicare Claims 文件，为这些患者提供廉价但可靠的临床信息 学习。通过这三个相关的项目，我试图确定 医疗保险化疗声明在获取三个关键信息时的可靠性 抗癌治疗要素1)化疗用药，2) 化疗相关的毒性，以及3)无病生存。为了满足这些要求 三个目标，我将通过将联邦医疗保险索赔联系起来，创建一个新的和独特的数据集 关于化疗的临床信息的黄金标准 管理和结果，癌症和白血病B组(CALGB)临床 试验数据。将CALGB数据定义为黄金标准 比较医疗保险索赔，然后我将计算敏感度和 医疗保险声明在获取化疗方面的特殊性 给药，以及2)特定的化疗相关毒性，以及3) 无病生存。在我职业生涯的下一个阶段，我将使用联邦医疗保险 声称，在其有效性范围内，执行一系列流行病学 老年患者化疗利用和疗效的研究 患有癌症和医学共病的美国人。

DESCRIPTION (provided by applicant): Although they present more than half of all Americans with cancer, the elderly are under-represented on the clinical trials that seek to determine efficacy and toxicity of chemotherapy. For this reason, results of clinical trials may not be applicable to the general population of elderly cancer patients. Nonetheless, physicians need clinical information regarding tile risks and benefits of chemotherapy in this substantial group of patients. I am a medical oncologist who seeks to develop a career at the crossroads oncology and health services research that is focused on determining the risks and benefits of chemotherapy in the general population of elderly cancer patients. In five years, I want to be able to execute a series of epidemiologic studies examining the possible contribution of medical comorbidity to the chemotherapy utilization and outcomes of elderly Americans with cancer. This long-term research agenda requires additional training on my part and three preliminary studies to determine the ability of a candidate data source, Heath Care Financing Administration's Medicare claims files, to provide inexpensive but reliable clinical information for these studies. Through the three related projects, I seek to determine the reliability of Medicare chemotherapy claims at capturing three critical elements of anti-cancer therapy 1) chemotherapy administration, 2) chemotherapy-related toxicities, and 3) disease-free survival. To meet these three aims, I will create a new and unique data set by linking Medicare claims to a gold-standard of clinical information regarding chemotherapy administration and outcomes, Cancer and Leukemia Group B (CALGB) clinical trial data. Defining the CALGB data as the gold standard against which to compare the Medicare claims, I will then calculate the sensitivity and specificity of the Medicare claims at capturing 1) chemotherapy administration, and 2) specific chemotherapy-related toxicities, and 3) disease-free survival. In the next phase of my career, I will use Medicare claims, to the extent of their validity, to execute a series of epidemiologic studies examining the chemotherapy utilization and outcomes of elderly Americans with cancer and medical comorbidity.