CLAIMS DATA TO MEASURE CANCER SURVEILLANCE PROCEDURES

对于接受可能治愈的初步治疗的患者，通常主张进行后续测试，以检测癌症复发和新的原发肿瘤，但关于测试的实际使用以及测试在不同患者亚组之间的差异，信息很少。癌症登记系统，如监测、流行病学和最终结果(SEER)计划，通常收集关于确诊后前三到四个月接受治疗的数据，因此，SEER不能用于研究最初疗程后的程序使用情况。因此，对后续测试的调查通常是通过审查个别提供者的纸质医疗记录进行的。在初步研究中，调查人员分析了健康计划和联邦医疗保险索赔，以确定结直肠癌初步治疗后的后续护理模式，并使用电子医疗记录来确定监测程序的适应症。由于与纸质图表相比，研究成本更低，更容易获取，健康声明和电子医疗记录都是研究监测程序的潜在重要数据来源。拟议研究的目标是确定纸质图表的两个替代来源--电子病历和健康索赔数据--的效用或完整性和准确性，作为监测测试的衡量标准。使用来自大型垂直整合提供商网络的数据，该网络既包括服务收费计划，也包括全国最大的管理保健计划之一，将研究一组患有局限性或区域性侵袭性前列腺癌、肺癌、结直肠癌、乳腺癌和子宫内膜癌以及非霍奇金淋巴瘤的患者。根据纸质和电子病历审查的结果，将制定一项关于检测的使用和适应症的综合黄金标准。下一阶段的研究将评估与综合黄金标准相比，服务费用和管理保健登记人员在衡量监测测试使用方面的健康索赔数据的准确性。还将确定利用索赔数据将后续行动模式归类为标准模式或强化模式的可行性。由于后续测试潜在的巨大经济和社会影响，以及纸质图表审查以外的数据匮乏，这是一个至关重要的调查领域。这项研究将为未来的调查提供方法论基础，这些调查将使用更大的、基于国家的电子数据来源来检查患者亚组之间的实践差异，以及各种监测策略的临床和经济影响。

Follow-up testing to detect cancer recurrence and new primary tumors is commonly advocated for patients who receive potentially curative initial therapy, but there is little information on the actual use of testing, as well as variation in testing across subgroups of patients. Cancer registry systems such as the Surveillance, Epidemiology and End Results (SEER) Program typically collect data on therapy received for the first three to four months following diagnosis, and thus SEER cannot be used to study the use of procedures after the initial course of treatment. Therefore, investigations of follow-up testing generally are performed by review of paper medical records from individual providers. In Preliminary Studies, the Investigators have analyzed health plan and Medicare claims to determine patterns of follow-up care after initial therapy for colorectal cancer, and have used the electronic medical record to ascertain the indication for surveillance procedures. Because of reduced research costs and easier accessibility compared to the paper chart, both health claims and the electronic medical record represent potentially important sources of data to study surveillance procedures. The goal of the proposed study is to determine the utility, or completeness and accuracy of two alternative sources to the paper chart - the electronic medical record and health claims data, as measures of surveillance testing. Using data from a large, vertically integrated provider network that includes both fee-for-service and one of the country's largest managed care plans, a cohort of patients with localized or regionally invasive prostate, lung, colorectal, breast, and endometrial cancer, and non-Hodgkin's lymphoma will be studied. Based on the results of paper and electronic medical record review, a composite gold standard measure for the use of and indication for testing will be developed. The next phase of the study will evaluate the accuracy of health claims data for both fee for service and managed care enrollees in measuring the use of surveillance testing, compared to the composite gold standard. The feasibility of using claims data to categorize patterns of follow up as standard or intensive will be also ascertained. Because of the potentially enormous economic and societal implications of follow-up testing, and the paucity of data from other than paper chart review, this represents a vital area of investigation. The study will provide a methodological basis for future investigations that will use larger, nationally-based sources of electronic data to examine variations in practice among patient subgroups, as well as the clinical and economic impact of various surveillance strategies.