Comparison of Comorbidity Collection Methods

描述(申请人提供)：50年来，癌症患者一直是根据肿瘤的大小进行分期和编制癌症统计数据，而不考虑患者因合并疾病或其他医疗健康状况而患病的程度。最近，几个国家癌症组织决定将共病信息作为癌症登记所需的数据元素。美国外科医师学会癌症委员会(ACOS)要求使用ICD-9系统，从2003年1月以后摘录的病例开始，从医院出院“面单”中收集共病信息。然而，广泛的研究表明，基于索赔的共病收集方法不如基于图表的方法准确和完整。由于没有一种公认的方法来收集合并症信息，而且一种方法的选择与其他方法有权衡，因此比较基于图表的方法和基于索赔的方法的性能是一个关键的卫生政策问题。这项研究的目的是评估哪种共病收集方法，基于图表或基于索赔，是基于医院的癌症登记最好的。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共病教育计划学习基于图表的共病编码的能力。2.使用网络共病教育计划中教授的方法评估共病编码的信度和效度。3.比较基于图表的共病评估和使用ICD-9编码系统的基于索赔的方法。我们计划在全美13家不同的医院和医疗保健系统招募75名癌症登记员。这些注册者将完成基于网络的共病教育计划，并使用该计划中教授的基于图表的方法对共病进行编码。登记人员将根据ACOS的要求，继续使用ICD-9系统从医院出院面单中对共病进行编码。我们计划评估哪种共病收集方法最适合以医院为基础的癌症登记。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，与使用ICD-9系统的基于声明的信息相比，基于图表的共病信息可以为更多的癌症患者捕获，与癌症护理和结果具有更大的相关性，并且具有更大的预后效用。然而，这种基于图表的方法需要癌症登记员进行特殊培训和额外的工作。评估癌症登记员通过审查病历对共病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卫生保健政策含义，因为它可以改善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并存健康信息的情况。

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.