Validation of Medicare Claims to Define Chemotherapy Use

描述（由申请人提供）：相关的SEER-医疗保险数据已迅速成为衡量癌症护理模式和结果的重要资源。除了登记数据之外，使用医疗保险索赔的优点是，它们允许研究人员纵向和跨站点跟踪护理。调查人员已经开始使用医疗保险索赔来描述特定的化疗药物。需要衡量的护理质量和增加的障碍，医疗记录审查表明，SEER医疗保险将成为一个越来越重要的资源，评估美国癌症护理。然而，迄今为止，很少有研究验证使用SEER医疗保险来衡量癌症治疗的特定方面。在IRB批准的方案背景下，我们提出了具体目标1：验证医疗保险索赔作为确定以下用途的资源：1）静脉化疗治疗; 2）特定化疗药物;以及：3）这些治疗的持续时间和频率。我们将通过将医疗保险索赔与纪念斯隆-凯特琳癌症中心和纽约医院网络附属的门诊血液治疗实践的“金标准”药房记录进行比较，来验证医疗保险索赔的使用，以确定化疗的使用。这项验证研究将告知卫生服务研究界， 使用医疗保险索赔作为了解静脉化疗使用的资源的可靠性。 如果我们确定医疗保险索赔对化疗的规格具有足够的敏感性，我们将 具体目标2：描述医生采用新化疗药物的比率，并探讨这一过程的可能决定因素。使用SEER医疗保险数据，我们将描述医生如何采用化疗药物的使用，以响应FDA的批准。我们将专门研究在20世纪90年代中期批准的药物，包括吉西他滨，紫杉醇，伊立替康和长春瑞滨。我们将描述医生采用每种药物治疗特定癌症的比率，并将确定与缓慢扩散相关的患者，肿瘤学家和药物相关参数。这些知识有可能为开发一种廉价而有效的系统来监测和提高美国癌症护理的质量奠定基础。

DESCRIPTION (provided by applicant): The linked SEER-Medicare data have rapidly become an important resource for measuring patterns and outcomes of cancer care. The advantage of using Medicare claims in addition to registry data is that they allow researchers to track care longitudinally and across sites. Investigators have begun to use Medicare claims to characterize particular chemotherapy drugs. The need to measure quality of care and increasing obstacles to medical record review indicate that SEER-Medicare will become an increasingly important resource for evaluating US cancer care. However, to date there have been few studies validating the use of SEER-Medicare to measure particular aspects of cancer treatment. Within the context of an IRB approved protocol, we propose Specific Aim 1: To validate Medicare claims as a resource for ascertaining use of: 1) intravenous chemotherapy treatment: 2) particular chemotherapeutic agents; and: 3) the duration and frequency of these treatments. We will validate the use of Medicare, claims for ascertaining chemotherapy use by comparing claims to "gold standard" pharmacy records from outpatient hemotherapy practices affiliated with Memorial Sloan-Kettering Cancer Center and the New York Hospital Network. This validation study will inform the health services research community about the reliability of using Medicare claims as a resource to understand the use of intravenous chemotherapy. If we determine Medicare claims have adequate sensitivity for specification of chemotherapy, we will address Specific Aim 2: To characterize the rate at which physicians adopt the use of new chemotherapeutic agents and to explore possible determinants of this process. Using SEER-Medicare data, we will describe how physicians adopted the use of chemotherapy drugs in response to FDA approval. We will specifically examine drugs approved in the mid-1990s including gemcitabine, paclitaxel, irinotecan and vinorelbine. We will characterize the rate at which physicians adopted each drug for specific cancers and, will identify patient, oncologist and drug-related parameters associated with slow diffusion. This knowledge has the potential to lay the groundwork for development of an inexpensive and efficient system for monitoring and improving the quality of US cancer care.