Building a Virtual Cancer Research Organization

Hornbrook, Mark C.; Hart, G. L.; Ellis, Jennifer L.; Bachman, Donald J.; Ansell, Gary; Greene, Sarah M.; Wagner, Edward H.; Pardee, Roy; Schmidt, M; Geiger, Ann M.; Butani, Amy; Field, Terry S.; Fouayzi, Hassan; Miroshnik, Irina; Liu, Liyan; Diseker, Robert A.; Wells, Karen; Krajenta, Richard; Lamerato, Lois; Dudas, Christine Neslund

doi:10.1093/jncimonographs/lgi033

Cited by 141 publications

(127 citation statements)

References 16 publications

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“…The details of the Network and the data sources used for this study have been described previously. 20,21 Funded by the National Cancer Institute under a cooperative agreement, the Network is a consortium of 14 research centers, which are affiliated with integrated health care systems that provide the continuum of cancer care for patients of all ages. The health care systems that participated in this study (Henry Ford Health System, Michigan; Group Health, Washington; and 4 Kaiser Permanente Regions-Colorado, Northwest [Oregon and southern Washington], and Northern and Southern California) are predominantly staff-model health care delivery systems.…”

Section: Settingmentioning

confidence: 99%

Racial differences in tumor stage and survival for colorectal cancer in an insured population

Doubeni

Field

Buist

et al. 2006

Cancer

110

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BACKGROUND: Despite declining death rates from colorectal cancer (CRC), racial disparities have continued to increase. In this study, the authors examined disparities in a racially diverse group of insured patients. METHODS: This study was conducted among patients who were diagnosed with CRC from 1993 to 1998, when they were enrolled in integrated healthcare systems. Patients were identified from tumor registries and were linked to information in administrative databases. The sample was restricted to non-Hispanic whites (n = 10,585), non-Hispanic blacks (n = 1479), Hispanics (n = 985), and Asians/Pacific Islanders (n = 909). Differences in tumor stage and survival were analyzed by using polytomous and Cox regression models, respectively. RESULTS: In multivariable regression analyses, blacks were more likely than whites to have distant or unstaged tumors. In Cox models that were adjusted for nonmutable factors, blacks had a higher risk of death from CRC (hazard ratio [HR], 1.17; 95% confidence interval [95% CI], 1.06-1.30). Hispanics had a risk of death similar to whites (HR, 1.04; 95% CI, 0.92-1.18), whereas Asians/Pacific Islanders had a lower risk of death from CRC (HR, 0.89; 95% CI, 0.78-1.02). Adjustment for tumor stage decreased the HR to 1.11 for blacks, and the addition of receipt of surgical therapy to the model decreased the HR further to 1.06. The HR among Hispanics and Asians/Pacific Islanders was stable to adjustment for tumor stage and surgical therapy. CONCLUSIONS: The relation between race and survival from CRC was complex and appeared to be related to differences in tumor stage and therapy received, even in insured populations. Targeted interventions to improve the use of effective screening and treatment among vulnerable populations may be needed to eliminate disparities in CRC

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Section: Settingmentioning

confidence: 99%

Racial differences in tumor stage and survival for colorectal cancer in an insured population

Doubeni

Field

Buist

et al. 2006

Cancer

110

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“…The following questions were addressed: All HMORN sites maintain a Virtual Data Warehouse (VDW) consisting of electronic medical record (EMR) and insurance claim data for their enrolled members. 24,25 Data on encounters, pharmacy fills, diagnoses, medical tests, and demographics are organized using the same definitions across sites and are quality checked locally. These data are matched to official regional mortality records using Social Security Numbers or patient names, birthdates, and demographic profiles.…”

Section: Introductionmentioning

confidence: 99%

Health Care Contacts in the Year Before Suicide Death

et al. 2014

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. Medical record, insurance claim, and mortality records were linked via the Virtual Data Warehouse, a federated data system at each site. KEY RESULTS: Nearly all individuals received health care in the year prior to death (83 %), but half did not have a mental health diagnosis. Only 24 % had a mental health diagnosis in the 4-week period prior to death. Medical specialty and primary care visits without a mental health diagnosis were the most common visit types. The individuals more likely to make a visit in the year prior to death (p<0.05) tended to be women, individuals of older age (65+ years), those where the neighborhood income was over $40,000 and 25 % were college graduates, and those who died by non-violent means. CONCLUSIONS: This study indicates that opportunities for suicide prevention exist in primary care and medical settings, where most individuals receive services prior to death. Efforts may target improved identification of mental illness and suicidal ideation, as a large proportion may remain undiagnosed at death.

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“…Previous research has found that expense patterns generated from SEER-Medicare and HMO data are roughly consistent (9)(10)(11); no studies, however, have systematically examined how cancer-specific and longitudinal patterns of resource and service use and overall expense differ between HMOs and Medicare. Building on the work of the Cancer Research Network [CRN (12)(13)(14)], the Burden of Cancer study (BURDEN) has developed a multisite, multipayer database to support analyses extending and complementing the linked SEER-Medicare data. Our study extends the literature on costs of cancer care to include nonaged adult HMO patients (aged 18-64 years) and adds HMO data to the literature that describes the cost experience for those aged 65 and over.…”

Section: Measuring the Medical Cost Of Cancermentioning

confidence: 99%

“…Data were standardized across health plans according to specifications established by the CRN's Virtual Data Warehouse (VDW) (12). In any analysis that compares utilization or cost data from multiple organizations or across delivery settings, it is critical that data be standardized to the largest extent possible.…”

Section: Data Sourcesmentioning

confidence: 99%

A Standardized Relative Resource Cost Model for Medical Care: Application to Cancer Control Programs

et al. 2013

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Medicare data represent 75% of aged and permanently disabled Medicare beneficiaries enrolled in the fee-for-service (FFS) indemnity option, but the data omit 25% of beneficiaries enrolled in Medicare Advantage health maintenance organizations (HMOs). Little research has examined how longitudinal patterns of utilization differ between HMOs and FFS. The Burden of Cancer Study developed and implemented an algorithm to assign standardized relative costs to HMO and Medicare FFS data consistently across time and place. Medicare uses 15 payment systems to reimburse FFS providers for covered services. The standardized relative resource cost algorithm (SRRCA) adapts these various payment systems to utilization data. We describe the rationale for modifications to the Medicare payment systems and discuss the implications of these modifications. We applied the SRRCA to data from four HMO sites and the linked Surveillance, Epidemiology, and End Results-Medicare data. Some modifications to Medicare payment systems were required, because data elements needed to categorize utilization were missing from both data sources. For example, data were not available to create episodes for home health services received, so we assigned costs per visit based on visit type (nurse, therapist, and aide). For inpatient utilization, we modified Medicare's payment algorithm by changing it from a flat payment per diagnosis-related group to daily rates for diagnosis-related groups to differentiate shorter versus longer stays. The SRRCA can be used in multiple managed care plans and across multiple FFS delivery systems within the United States to create consistent relative cost data for economic analyses. Prior to international use of the SRRCA, data need to be standardized.

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Building a Virtual Cancer Research Organization

Abstract: The CRN research management Web site and associated standardized data files and procedures represent a quasi-public resource, and the CRN stands ready to collaborate with researchers from outside institutions in developing and conducting innovative public domain research.

Cited by 141 publications

References 16 publications

Racial differences in tumor stage and survival for colorectal cancer in an insured population

Racial differences in tumor stage and survival for colorectal cancer in an insured population

Health Care Contacts in the Year Before Suicide Death

A Standardized Relative Resource Cost Model for Medical Care: Application to Cancer Control Programs

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