Structured Approach for Evaluating Strategies for Cancer Ascertainment Using Large-Scale Electronic Health Record Data
Structured Approach for Evaluating Strategies for Cancer Ascertainment Using Large-Scale Electronic Health Record Data
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DOI：
10.1200/cci.17.00072
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发表时间：
2018-02-20
影响因子：
4.2
通讯作者：
Gupta, Samir
中科院分区：
文献类型：
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作者：
Earles, Ashley;Liu, Lin;Gupta, Samir
目的：使用大规模电子健康记录来确定癌症是一项挑战。以美国退伍军人事务部(VA)内的结直肠癌(CRC)确诊为例，提出并应用一种结构化方法来评估多种癌症确定候选方法。方法所提出的癌症确定策略评估方法包括评估单个策略的表现、不同策略的一致性比较和不一致诊断的审查。我们应用这种方法来比较退伍军人事务部内用于确定CRC的三种策略：由国际疾病分类第九版(ICD9)诊断代码组成的行政索赔数据；退伍军人事务部癌症登记中心(VACCR)；以及新访问的肿瘤学领域，由当地癌症登记机构提取的病例组成。研究样本包括1,839,043名退伍军人，他们在1999年至2014年期间接受了指数结肠镜检查。基于100个候选结直肠癌病例和100个结肠镜对照病例的手动记录审查，评估特定策略的表现。结果共有92,197名患者符合至少一种结直肠癌定义。三种策略对急性结直肠癌均有较高的敏感性和特异性。然而，基于ICD9的策略显示出较差的阳性预测价值(58%)。VACCR和肿瘤学领域几乎完全符合彼此(kappa，0.87)，但与基于ICD9的诊断只有中等的一致性(kappa，分别为0.51和0.57)。在回顾的不一致病例中，ICD9阳性但VACCR或肿瘤学领域阴性的病例中有15%发生了CRC。结论评估新的癌症识别策略需要结构化的方法，包括对照手动记录审查进行验证，候选策略之间的一致性，以及对不一致结果的集中审查。如果不认真评估确定方法，分析可能会产生偏差，并限制临床影响。(C)2018年美国临床肿瘤学会
Purpose Cancer ascertainment using large-scale electronic health records is a challenge. Our aim was to propose and apply a structured approach for evaluating multiple candidate approaches for cancer ascertainment using colorectal cancer (CRC) ascertainment within the US Department of Veterans Affairs (VA) as a use case.Methods The proposed approach for evaluating cancer ascertainment strategies includes assessment of individual strategy performance, comparison of agreement across strategies, and review of discordant diagnoses. We applied this approach to compare three strategies for CRC ascertainment within the VA: administrative claims data consisting of International Classification of Diseases, Ninth Revision (ICD9) diagnosis codes; the VA Central Cancer Registry (VACCR); and the newly accessible Oncology Domain, consisting of cases abstracted by local cancer registrars. The study sample consisted of 1,839,043 veterans with index colonoscopy performed from 1999 to 2014. Strategy-specific performance was estimated based on manual record review of 100 candidate CRC cases and 100 colonoscopy controls. Strategies were further compared using Cohen's K and focused review of discordant CRC diagnoses.Results A total of 92,197 individuals met at least one CRC definition. All three strategies had high sensitivity and specificity for incident CRC. However, the ICD9-based strategy demonstrated poor positive predictive value (58%). VACCR and Oncology Domain had almost perfect agreement with each other (kappa, 0.87) but only moderate agreement with ICD9-based diagnoses (kappa, 0.51 and 0.57, respectively). Among discordant cases reviewed, 15% of ICD9-positive but VACCR- or Oncology Domain-negative cases had incident CRC.Conclusion Evaluating novel strategies for identifying cancer requires a structured approach, including validation against manual record review, agreement among candidate strategies, and focused review of discordant findings. Without careful assessment of ascertainment methods, analyses may be subject to bias and limited in clinical impact. (C) 2018 by American Society of Clinical Oncology