Comparison of Comorbidity Collection Methods

描述（由申请人提供）：50年来，癌症患者的分期和癌症统计数据是基于肿瘤的大小而编制的，而不考虑患者因合并症或其他医疗和健康状况而患病的程度。最近，几个国家癌症组织决定将合并症信息作为癌症登记所需的数据元素。美国外科医生学会癌症委员会（ACoS）要求使用ICD-9系统从2003年1月以后提取的病例开始，从出院“面单”中收集合并症信息。然而，广泛的研究表明，基于索赔的方法来收集合并症是不准确和完整的比基于图表的方法。由于没有单一的商定方法收集合并症信息和选择一种方法有权衡与其他方法，这是一个关键的卫生政策问题，比较基于图表的方法，以索赔为基础的方法的性能。本研究的目的是评估哪种合并症收集方法，基于图表或基于声明，是最适合医院癌症登记的方法。本研究项目的三个具体目标是：1。评估不同医院和癌症护理机构的大量癌症登记员使用基于网络的合并症教育计划学习基于图表的合并症编码的能力。2.以网路共构码教育课程所教授的方法，评估共构码的信度与效度。3.比较基于图表的合并症评估与使用ICD-9编码系统的基于索赔的方法。我们计划在美国13家不同的医院和医疗保健系统招募75名癌症登记员。这些注册商将完成基于Web的域名教育计划，并使用该计划中教授的基于图表的方法编写域名代码。登记员将继续按照ACoS的要求，使用ICD-9系统对出院表中的合并症进行编码。我们计划评估哪种合并症收集方法最适合医院癌症登记。我们还将采访癌症专家，请他们评估每种方法提供的信息，说明他们更喜欢哪种方法，并解释他们的理由。我们假设，基于图表的合并症信息可以捕获更多的癌症患者，与癌症护理和结局更相关，并且比使用ICD-9系统的基于索赔的信息具有更大的预后效用。然而，基于图表的方法需要癌症登记员的特殊培训和额外工作。评估癌症登记员从病历审查中对合并症进行编码的能力以及这样做所需的时间是很重要的。本申请中描述的研究具有重要的医疗保健政策意义，因为它可能导致医院癌症登记员为新诊断的癌症患者大规模收集令人信服的共病健康信息的改进。

DESCRIPTION (provided by applicant): For fifty years, patients with cancer have been staged and cancer statistics compiled based on how big the tumor is without consideration of how sick the patient is from comorbidity or other medical and health conditions. Recently, several national cancer organizations decided to include comorbidity information as a required data element for cancer registries. The American College of Surgeons Commission on Cancer (ACoS) mandated the collection of comorbidity information, using the ICD-9 system, from the hospital discharge "face sheet" beginning with cases abstracted after January 2003. However, extensive research has demonstrated that a claims based approach to comorbidity collection is less accurate and complete than a chart-based approach. Since there is no single agreed upon method for collecting comorbidity information and selection of one method has trade-offs with other methods, it is a critical health policy question to compare the performance of a chart-based approach to a claims-based approach. The goal of this research is to assess which comorbidity collection method, chart-based or claims- based, is the best for hospital-based cancer registries. The three Specific Aims of this research project are: 1. To assess the ability of a large number of cancer registrars in different hospitals and cancer care settings to learn chart-based comorbidity coding using the Web-Based Comorbidity Education Program. 2. To evaluate the reliability and validity of comorbidity coding using the approach taught in the Web- Based Comorbidity Education Program. 3. To compare chart-based comorbidity assessment with a claims-based approach using the ICD-9 coding system. We plan to enroll 75 cancer registrars at 13 different hospitals and health care systems across the United States. These registrars will complete the Web-Based Comorbidity Education Program and code comorbidity using the chart-based approach taught in the Program. The registrars will continue to code comorbidity using the ICD-9 system from the hospital discharge face sheet as mandated by the ACoS. We plan to assess which comorbidity collection method is best for hospital-based cancer registries. We will also interview cancer specialists to ask them to evaluate the information provided by each approach, state which approach they prefer, and explain their reasons. We hypothesize that chart-based comorbidity information can be captured for a greater number of cancer patients, nave greater relevance to cancer care and outcomes, and have greater prognostic utility than claims-based information using the ICD-9 system. However, the chart-based approach requires special training and additional work by the cancer registrars. Assessment of the ability of cancer registrars to code comorbidity from the review of the medical record and the time required to do so is important. The research described in this application has significant health care policy implications because it could lead to improvements in the large-scale collection of cogent comorbid health information for newly diagnosed cancer patients by hospital-based cancer registrars.