Validation of Medicare Claims Data for Mammography

乳房 X 光检查的医疗保险索赔数据验证

• 批准号: 8244989
• 负责人: Joshua J Fenton
• 金额: $ 17.16万
• 依托单位: UNIVERSITY OF CALIFORNIA AT DAVIS
• 依托单位国家: 美国
• 财政年份: 2011
• 资助国家: 美国
• 起止时间: 2011-04-01 至 2014-03-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8244989
• 关键词: Algorithms; Breast; Breast Cancer Surveillance Consortium; Cancer Detection; Catchment Area; Classification; Clinical; Code; Congresses; Data; Data Element; Data Sources; Diagnostic; Diffusion; Digital Computers; Digital Mammography; Economics; Enrollment; Evaluation; Event; Evolution; Fees; Film; Gold; Health; Information Systems; Link; Malignant Neoplasms; Mammography; Measures; Medicare; Medicare claim; NIH Program Announcements; Patient Noncompliance; Patients; Performance; Policies; Population; Procedures; Recording of previous events; Reference Standards; Reporting; Research; Sampling; Screening procedure; Technology; Testing; Ultrasonography; Uncertainty; Update; Validation; Woman; aged; base; comparative effectiveness; computer aided detection; digital; economic impact; effectiveness research; follow-up; improved; malignant breast neoplasm; public health priorities; public health relevance; radiologist; research clinical testing; response

DESCRIPTION (provided by applicant): Over one-half of incident breast cancers occur among Medicare-enrolled women, and Medicare enrollees receive approximately one-third of all screening mammograms nationwide (~13 million annual mammograms). Thus, improving the quality of screening mammography received by Medicare enrollees remains a public health priority. In 2001, Congress extended Medicare coverage to digital mammography and the application of computer-aided detection (CAD) during screening mammography. Rigorous evaluation of the clinical and economic impact of dissemination these technologies within the Medicare population have substantial policy significance. Although Medicare claims could be fruitful data source for such evaluations, uncertainty remains about the validity of key data elements. The Program Announcement, "Cancer Surveillance Using Health Claims-based Data System," calls for research to expand the scientific utility of Medicare claims files. In response, this study will use the newly linked Breast Cancer Surveillance Consortium (BCSC)-Medicare data to validate critical data elements of Medicare mammography claims and to evaluate the performance of claims-based algorithms for distinguishing screening from diagnostic mammograms and normal from abnormal radiologist interpretations. Specific aims are: 1) To refine and validate a promising claims-based algorithm to distinguish screening from diagnostic mammograms. 2) To externally validate claims procedure codes for digital mammography and computer-aided detection (CAD). 3) To develop and validate a claims-based algorithm to distinguish whether screening mammograms were interpreted as normal vs. abnormal. Analyses will demonstrate the potential utility of the claims algorithms for comparative effectiveness research or radiologist-level quality assessment in the context of mammography technology diffusion. PUBLIC HEALTH RELEVANCE: This study may provide essential methodological support for subsequent claims-based comparative effectiveness, economic, quality improvement research related to mammography. By elucidating the strengths and weaknesses of the claims data, study findings may also direct programmatic efforts to improve the quality of Medicare claims data.

描述（由申请人提供）：超过一半的乳腺癌发生在参加 Medicare 的女性中，而 Medicare 参保者接受的乳房 X 光检查占全国筛查乳房 X 光检查的大约三分之一（每年约 1,300 万张乳房 X 光检查）。因此，提高医疗保险参保者接受的乳房 X 光检查的质量仍然是公共卫生的优先事项。 2001 年，国会将医疗保险覆盖范围扩大到数字乳房 X 光检查以及筛查乳房 X 光检查期间计算机辅助检测 (CAD) 的应用。对在医疗保险人群中传播这些技术的临床和经济影响进行严格评估具有重大的政策意义。尽管医疗保险索赔可能是此类评估的有效数据源，但关键数据元素的有效性仍然存在不确定性。 该计划公告“使用基于健康索赔的数据系统进行癌症监测”呼吁开展研究以扩大医疗保险索赔文件的科学用途。作为回应，本研究将使用新链接的乳腺癌监测联盟 (BCSC)-医疗保险数据来验证医疗保险乳房 X 光检查索赔的关键数据元素，并评估基于索赔的算法的性能，以区分筛查与诊断乳房 X 光检查以及正常与异常放射科医生的解释。具体目标是：1）完善和验证一种有前景的基于声明的算法，以区分筛查和诊断性乳房X光检查。 2) 从外部验证数字乳房 X 线摄影和计算机辅助检测 (CAD) 的索赔程序代码。 3) 开发并验证基于索赔的算法，以区分筛查性乳房 X 光检查是否被解释为正常与异常。 分析将证明索赔算法在乳腺 X 线摄影技术推广背景下用于比较有效性研究或放射科医生级别质量评估的潜在效用。 公共卫生相关性：这项研究可能为后续与乳房 X 光检查相关的基于索赔的比较有效性、经济性、质量改进研究提供必要的方法论支持。通过阐明索赔数据的优点和缺点，研究结果还可以指导提高医疗保险索赔数据质量的计划工作。