Comparison of Comorbidity Collection Methods

50年来，癌症患者一直被分期，并根据肿瘤的大小编制癌症统计数据 肿瘤并不考虑患者的合并症或其他医疗健康问题。 条件。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。美国外科医生协会癌症委员会 (ACOS)授权使用ICD-9系统从医院收集共病信息 从2003年1月以后摘录的案件开始，出院“面单”。然而，广泛的研究 已经证明，基于索赔的合并症收集方法不如 一种基于图表的方法。由于没有单一商定方法来收集合并症信息 而选择一种方法与其他方法是有权衡的，这是一个关键的卫生政策问题 比较基于图表的方法和基于索赔的方法的性能。 这项研究的目标是评估哪种共病收集方法，基于图表或声称- 基于，是以医院为基础的癌症登记的最佳选择。 这项研究项目的三个具体目标是： 1.评估不同医院大量癌症登记员的能力和癌症护理 使用基于网络的共病教育学习基于图表的共病编码的设置 程序。 2.使用在网上教授的方法评估共病编码的可靠性和有效性- 以共病教育为基础的计划。 3.使用ICD-9比较基于图表的共病评估和基于索赔的方法 编码系统。 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 各州。这些注册人将完成基于网络的共病教育计划和代码 使用方案中讲授的基于图表的方法进行合并症。登记人员将继续编码 按照美国儿科医生协会的要求，使用ICD-9系统从医院出院“面单”中使用共病。 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。我们会 还采访了癌症专家，请他们评估每种方法提供的信息 他们更喜欢哪种方式，并解释他们的理由。 我们假设，基于图表的共病信息可以被捕捉到更多数量的癌症 患者与癌症护理和预后的相关性更大，对预后的效用也更大 使用ICD-9系统的基于索赔的信息。然而，基于图表的方法需要特殊的 癌症登记员的培训和额外工作。癌症登记人员编码能力的评估 审查病历和检查所需时间引起的共病是重要的。这项研究 此应用程序中描述的内容具有重大的医疗保健政策含义，因为它可能导致 为新诊断的癌症大规模收集令人信服的共病健康信息方面的改进 由医院的癌症登记员登记的患者。

For fifty years, patients with cancer nave 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.