Abstract
Background: Description of care patterns is important as evidence-based guidelines increasingly dictate care. We explore the level of agreement between claims and record abstraction for guideline concordant multidisciplinary breast cancer care. Methods: From the U.S. Centers for Disease Control and Prevention's National Program of Cancer Registries Patterns of Care study, in which medical record abstraction of breast cancer and treatment was accomplished, cases include breast cancer where Medicare claims were available. Components of care were breast-conserving surgery (BCS), mastectomy, node assessment, radiation (RT), and chemotherapy (CTX), including specific chemotherapeutic agents, and combinations. We compared Medicare claims with record abstraction, and measured concordance using the kappa statistic and sensitivity. Results: The study sample consisted of 1762 women with stage 0 to 4 breast cancer. Level of agreement was excellent for surgery type (kappa = 0.84) and CTX (kappa = 0.89); agreement for RT therapy was slightly lower (kappa = 0.79). For standard multicomponent strategies, sensitivities and specificities were high; for example, 88.8%/93.5% for mastectomy plus nodes and 86.6%/95.4% for BCS plus nodes and RT. For selected, standard, multi-agent, adjuvant CTX regimens, sensitivities ranged from 66.3% to 68.8% (kappa 0.63-0.73). Conclusions: Medicare claims, compared with chart abstraction, is a reliable method for determining patterns of multicomponent care for breast cancer.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 807-813 |
| Number of pages | 7 |
| Journal | Annals of Epidemiology |
| Volume | 22 |
| Issue number | 11 |
| DOIs | |
| State | Published - Nov 2012 |
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Keywords
- Breast neoplasm
- Claims analysis
- Clinical practice
- Medical records
- Medicare
- Patterns
ASJC Scopus subject areas
- Epidemiology
Cite this
Defining care provided for breast cancer based on medical record review or Medicare claims : Information from the Centers for Disease Control and Prevention Patterns of Care Study. / Fleming, Steven T.; Kimmick, Gretchen G.; Sabatino, Susan A.; Cress, Rosemary D; Wu, Xiao Cheng; Trentham-Dietz, Amy; Huang, Bin; Hwang, Wenke; Liff, Jonathan M.
In: Annals of Epidemiology, Vol. 22, No. 11, 11.2012, p. 807-813.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Defining care provided for breast cancer based on medical record review or Medicare claims
T2 - Information from the Centers for Disease Control and Prevention Patterns of Care Study
AU - Fleming, Steven T.
AU - Kimmick, Gretchen G.
AU - Sabatino, Susan A.
AU - Cress, Rosemary D
AU - Wu, Xiao Cheng
AU - Trentham-Dietz, Amy
AU - Huang, Bin
AU - Hwang, Wenke
AU - Liff, Jonathan M.
PY - 2012/11
Y1 - 2012/11
N2 - Background: Description of care patterns is important as evidence-based guidelines increasingly dictate care. We explore the level of agreement between claims and record abstraction for guideline concordant multidisciplinary breast cancer care. Methods: From the U.S. Centers for Disease Control and Prevention's National Program of Cancer Registries Patterns of Care study, in which medical record abstraction of breast cancer and treatment was accomplished, cases include breast cancer where Medicare claims were available. Components of care were breast-conserving surgery (BCS), mastectomy, node assessment, radiation (RT), and chemotherapy (CTX), including specific chemotherapeutic agents, and combinations. We compared Medicare claims with record abstraction, and measured concordance using the kappa statistic and sensitivity. Results: The study sample consisted of 1762 women with stage 0 to 4 breast cancer. Level of agreement was excellent for surgery type (kappa = 0.84) and CTX (kappa = 0.89); agreement for RT therapy was slightly lower (kappa = 0.79). For standard multicomponent strategies, sensitivities and specificities were high; for example, 88.8%/93.5% for mastectomy plus nodes and 86.6%/95.4% for BCS plus nodes and RT. For selected, standard, multi-agent, adjuvant CTX regimens, sensitivities ranged from 66.3% to 68.8% (kappa 0.63-0.73). Conclusions: Medicare claims, compared with chart abstraction, is a reliable method for determining patterns of multicomponent care for breast cancer.
AB - Background: Description of care patterns is important as evidence-based guidelines increasingly dictate care. We explore the level of agreement between claims and record abstraction for guideline concordant multidisciplinary breast cancer care. Methods: From the U.S. Centers for Disease Control and Prevention's National Program of Cancer Registries Patterns of Care study, in which medical record abstraction of breast cancer and treatment was accomplished, cases include breast cancer where Medicare claims were available. Components of care were breast-conserving surgery (BCS), mastectomy, node assessment, radiation (RT), and chemotherapy (CTX), including specific chemotherapeutic agents, and combinations. We compared Medicare claims with record abstraction, and measured concordance using the kappa statistic and sensitivity. Results: The study sample consisted of 1762 women with stage 0 to 4 breast cancer. Level of agreement was excellent for surgery type (kappa = 0.84) and CTX (kappa = 0.89); agreement for RT therapy was slightly lower (kappa = 0.79). For standard multicomponent strategies, sensitivities and specificities were high; for example, 88.8%/93.5% for mastectomy plus nodes and 86.6%/95.4% for BCS plus nodes and RT. For selected, standard, multi-agent, adjuvant CTX regimens, sensitivities ranged from 66.3% to 68.8% (kappa 0.63-0.73). Conclusions: Medicare claims, compared with chart abstraction, is a reliable method for determining patterns of multicomponent care for breast cancer.
KW - Breast neoplasm
KW - Claims analysis
KW - Clinical practice
KW - Medical records
KW - Medicare
KW - Patterns
UR - http://www.scopus.com/inward/record.url?scp=84868191820&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=84868191820&partnerID=8YFLogxK
U2 - 10.1016/j.annepidem.2012.08.001
DO - 10.1016/j.annepidem.2012.08.001
M3 - Article
C2 - 22948184
AN - SCOPUS:84868191820
VL - 22
SP - 807
EP - 813
JO - Annals of Epidemiology
JF - Annals of Epidemiology
SN - 1047-2797
IS - 11
ER -