Do Medicare Claims Measure Chemotherapy Use and Outcomes

描述（由申请人提供）：虽然他们提出了一半以上的 所有患有癌症的美国人，老年人在临床上的代表性不足， 旨在确定化疗疗效和毒性的试验。 为此 临床试验的结果可能不适用于一般情况， 老年癌症患者。 然而，医生需要临床 关于化疗的风险和益处的信息， 大量的病人。 我是一名肿瘤学家， 在十字路口肿瘤学和健康服务研究的职业生涯， 重点是确定化疗的风险和益处， 老年癌症患者。 五年后，我希望能够 进行一系列流行病学研究， 老年人化疗药物使用和预后的医疗因素分析 美国癌症患者 这一长期研究议程需要更多的 对我的培训部分和三个初步的研究，以确定能力， 一个候选数据源，医疗保健融资管理局的医疗保险索赔 文件，为这些患者提供廉价但可靠的临床信息。 问题研究 通过这三个相关的项目，我试图确定 医疗保险化疗索赔在捕获三个关键 抗癌治疗的要素1）化疗给药，2） 化疗相关毒性，和3）无病生存。 满足这些 三个目标，我将创建一个新的和独特的数据集， 化疗临床信息的黄金标准 给药和结局，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，然后我将计算敏感性， 医疗保险索赔在捕获1）化疗方面的特异性 给药，和2）特异性化疗相关毒性，和3） 无病生存率 在我职业生涯的下一个阶段，我将使用医疗保险， 声称，在其有效性的范围内，执行一系列流行病学 研究检查老年人的化疗利用和结果 美国癌症患者和医疗并发症。

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.