CLAIMS DATA TO MEASURE CANCER SURVEILLANCE PROCEDURES

对于接受潜在治愈性初始治疗的患者，通常主张进行随访检测以检测癌症复发和新的原发性肿瘤，但关于测试的实际使用以及患者亚组之间测试的变化的信息很少。 癌症登记系统，如监测、流行病学和最终结果（SEER）计划，通常收集诊断后前三到四个月接受的治疗数据，因此SEER不能用于研究初始疗程后的程序使用。 因此，随访检测的调查通常通过审查个人提供者的纸质病历来进行。 在初步研究中，研究人员分析了健康计划和医疗保险索赔，以确定结直肠癌初始治疗后的随访护理模式，并使用电子病历确定监测程序的适应症。 由于与纸质图表相比，研究成本降低且更容易获得，健康声明和电子病历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作为监测测试措施的实用性或完整性和准确性。 使用来自一个大型的垂直整合提供商网络的数据，该网络包括收费服务和该国最大的管理式医疗计划之一，将研究一组患有局部或区域浸润性前列腺癌，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，将开发一种用于检测的使用和适应症的复合金标准措施。 该研究的下一阶段将评估与复合金标准相比，服务费和管理式医疗注册者在测量监测检测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分类为标准或密集的可行性。由于后续测试的潜在巨大的经济和社会影响，以及缺乏来自纸质图表审查以外的数据，这是一个重要的调查领域。 该研究将为未来的研究提供方法学基础，这些研究将使用更大的、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.