CLAIMS DATA TO MEASURE CANCER SURVEILLANCE PROCEDURES

对于接受潜在治愈性初始治疗的患者，通常提倡进行随访检测以检测癌症复发和新的原发肿瘤，但关于检测的实际使用以及不同亚组患者检测的差异的信息很少。癌症登记系统，如监测、流行病学和最终结果（SEER）项目，通常收集诊断后三到四个月接受治疗的数据，因此SEER不能用于研究初始治疗过程后的程序使用情况。因此，对后续检测的调查一般是通过审查个别提供者的纸质医疗记录来进行的。在初步研究中，研究人员分析了健康计划和医疗保险要求，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指征。与纸质图表相比，健康声明和电子病历降低了研究成本，而且更容易获得，因此它们都可能成为研究监测程序的重要数据来源。拟议研究的目标是确定纸质图表的两个替代来源——电子医疗记录和健康索赔数据——作为监测测试措施的效用，或完整性和准确性。使用来自大型垂直整合供应商网络的数据，包括按服务收费和全国最大的管理医疗计划之一，将研究一组患有局部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。将根据纸质和电子病历审查的结果，制定用于检测的使用和指示的综合金标准措施。研究的下一阶段将评估服务收费和管理式医疗登记人的健康声明数据的准确性，以衡量监测测试的使用情况，并与综合金标准进行比较。还将确定使用索赔数据将随访模式分类为标准或密集模式的可行性。由于后续测试的潜在巨大经济和社会影响，以及除了纸质图表审查之外数据的缺乏，这代表了一个重要的调查领域。该研究将为未来的调查提供方法学基础，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实践中的变化，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.