Comparison of Comorbidity Collection Methods

50年来，癌症患者一直被分期，癌症统计数据是根据肿瘤的大小来编制的。 肿瘤是不考虑如何生病的病人是从comorphism或其他医疗和健康 条件最近，几个国家癌症组织决定将合并症信息作为 癌症登记所需的数据元素。美国外科医生学会癌症委员会 （ACoS）要求使用ICD-9系统从医院收集合并症信息， 从2003年1月以后提取的病例开始。然而，广泛的研究 已经证明，以索赔为基础的合并索赔收集方法的准确性和完整性低于 基于图表的方法。由于没有统一的商定方法来收集共同体信息， 选择一种方法与其他方法有权衡，这是一个关键的卫生政策问题， 比较基于图表的方法和基于声明的方法的性能。 本研究的目的是评估哪种合并症收集方法，基于图表或索赔- 是医院癌症登记的最佳选择。 本研究项目的三个具体目标是： 1.评估不同医院和癌症护理中大量癌症登记员的能力 使用基于Web的Comorbian Education学习基于图表的Comorbian编码的设置 程序. 2.为了评估使用网络上教授的方法进行共现编码的信度和效度， 科摩罗教育方案。 3.比较基于图表的合并症评估与使用ICD-9的基于索赔的方法 编码系统 我们计划在美国13家不同的医院和医疗保健系统招募75名癌症登记员， States.这些注册商将完成基于Web的科摩罗教育计划和代码 使用该计划中教授的基于图表的方法进行协调。注册商将继续编码 根据ACoS的要求，使用医院出院单中的ICD-9系统进行合并。 我们计划评估哪种合并症收集方法最适合医院癌症登记。我们将 还采访癌症专家，请他们评估每种方法提供的信息， 他们更喜欢哪种方法，并解释他们的理由。 我们假设，基于图表的合并症信息可以捕获更多的癌症， 患者，与癌症护理和结局的相关性更大，并且具有更大的预后效用， 使用ICD-9系统的索赔信息。然而，基于图表的方法需要特殊的 癌症登记员的培训和额外工作。癌症登记员编码能力评估 审查病历的时间和所需的时间很重要。研究 本申请中所描述的具有重大的医疗保健政策含义，因为它可能导致 改善新诊断癌症的大规模令人信服的共病健康信息收集 医院癌症登记处的病人。

For fifty years, patients with cancer nave been staged and cancer statistics compiled based on how big the tumor is without consideration of how sick the patient is from comorbidity or other medical and health conditions. Recently, several national cancer organizations decided to include comorbidity information as a required data element for cancer registries. The American College of Surgeons Commission on Cancer (ACoS) mandated the collection of comorbidity information, using the ICD-9 system, from the hospital discharge "face sheet" beginning with cases abstracted after January 2003. However, extensive research has demonstrated that a claims^based approach to comorbidity collection is less accurate and complete than a chart-based approach. Since there is no single agreed upon method for collecting comorbidity information and selection of one method has trade-offs with other methods, it is a critical health policy question to compare the performance of a chart-based approach to a claims-based approach. The Goal of this research is to assess which comorbidity collection method, chart-based or claims- based, is the best for hospital-based cancer registries. The three Specific Aims of this research project are: 1. To assess the ability of a large number of cancer registrars in different hospitals and cancer care settings to learn chart-based comorbidity coding using the Web-Based Comorbidity Education Program. 2. To evaluate the reliability and validity of comorbidity coding using the approach taught in the Web- Based Comorbidity Education Program. 3. To compare chart-based comorbidity assessment with a claims-based approach using the ICD-9 coding system. We plan to enroll 75 cancer registrars at 13 different hospitals and health care systems across the United States. These registrars will complete the Web-Based Comorbidity Education Program and code comorbidity using the chart-based approach taught in the Program. The registrars will continue to code comorbidity using the ICD-9 system from the hospital discharge "face sheet as mandated by the ACoS. We plan to assess which comorbidity collection method is best for hospital-based cancer registries. We will also interview cancer specialists to ask them to evaluate the information provided by each approach, state which approach they prefer, and explain their reasons. We hypothesize that chart-based comorbidity information can be captured for a greater number of cancer patients, nave greater relevance to cancer care and outcomes, and have greater prognostic utility than claims-based information using the ICD-9 system. However, the chart-based approach requires special training and additional work by the cancer registrars. Assessment of the ability of cancer registrars to code comorbidity from the review of the medical record and the time required to do so is important. The research described in this application has significant health care policy implications because it could lead to improvements in the large-scale collection of cogent comorbid health information for newly diagnosed cancer patients by hospital-based cancer registrars.