Leveraging Linkage of Cohort Studies With Administrative Claims Data to Identify Individuals With Cancer

Bronson, Mackenzie; Kapadia, Nirav S.; Austin, Andrea M.; Wang, Qianfei; Feskanich, Diane; Bynum, Julie; Grodstein, Francine

doi:10.1097/mlr.0000000000000875

Cited by 24 publications

(39 citation statements)

References 15 publications

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“…This application of the NHS data has begun in studies of cancer, preventive care, and cognitive impairment. [24][25][26] Concerns about generalizability also motivated comparing with men, in which we found no difference in early disease but larger differences at the EOL. EOL care differences between the nurses and men may be driven by sex as well as professional healthcare experience.…”

Section: Discussionmentioning

confidence: 70%

Serious Illness and End‐of‐Life Treatments for Nurses Compared with the General Population

Bynum

Passow

Austin

et al. 2019

J American Geriatrics Society

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OBJECTIVES As key team members caring for people with advanced illness, nurses teach patients and families about managing their illnesses and help them to understand their options. Our objective was to determine if nurses' personal healthcare experience with serious illness and end‐of‐life (EOL) care differs from the general population as was shown for physicians. DESIGN Observational propensity‐matched cohort study. SETTING Fee‐for‐service Medicare. PARTICIPANTS Nurses' Health Study (NHS) and a random 20% national sample of Medicare beneficiaries aged 66 years or older with Alzheimer's disease and related dementias (ADRD) or congestive heart failure (CHF) diagnosed in the hospital. MEASUREMENTS Characteristics of care during the first year after diagnosis and the last 6 months of life (EOL). RESULTS Among 57 660 NHS participants, 7380 had ADRD and 5375 had CHF; 3227 ADRD patients and 2899 CHF patients subsequently died. Care patterns in the first year were similar for NHS participants and the matched national sample: hospitalization rates, emergency visits, and preventable hospitalizations were no different in either disease. Ambulatory visits were slightly higher for NHS participants than the national sample with ADRD (13.1 vs 12.5 visits; P < .01) and with CHF (13.7 vs 12.5; P < .001). Decedents in the NHS and national sample had similar acute care use (hospitalization and emergency visits) in both diseases, but those with ADRD were less likely to use life‐prolonging treatments such as mechanical ventilation (10.9% vs 13.5%; P = .001), less likely to die in a hospital with a stay in the intensive care unit (10.4% vs 12.1%; P = .03), and more likely to use hospice (58.9% vs 54.8%; P < .001). CHF at the EOL results were similar. CONCLUSIONS Nurses with newly identified serious illness experience similar care as the general Medicare population. However, at EOL, nurses are more likely to choose less aggressive treatments than the patients for whom they care. J Am Geriatr Soc 67:1582–1589, 2019

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Section: Discussionmentioning

confidence: 70%

Serious Illness and End‐of‐Life Treatments for Nurses Compared with the General Population

Bynum

Passow

Austin

et al. 2019

J American Geriatrics Society

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“…Previous research has suggested that claims data alone without linkage to a tumor registry may be insufficient to comprehensively characterize cancer incidence (17). However, other investigators have developed and validated algorithms to support reliable inference of cancer incidence and stage from claims data (7)(8)(9)(10)(11).…”

Section: Identifying Incident Cancersmentioning

confidence: 99%

“…Longitudinal claims data are useful for documenting use of procedures, irrespective of the care setting, and for examining the temporal relationship between procedures and clinical events. Importantly, researchers have developed and validated effective means of using claims data to classify cancers by stage, expanding the utility of claims data for cancer health services research (7)(8)(9)(10)(11). Claims data are also useful in documenting patterns of routine care, which may reveal opportunities for intervention such as counseling patients regarding healthy behaviors and the importance of cancer screening.…”

Section: Introductionmentioning

confidence: 99%

Association of Breast Cancer Screening Behaviors With Stage at Breast Cancer Diagnosis and Potential for Additive Multi-Cancer Detection via Liquid Biopsy Screening: A Claims-Based Study

Hathaway

Paetsch²,

et al. 2021

Front. Oncol.

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PurposeTo evaluate mammography uptake and subsequent breast cancer diagnoses, as well as the prospect of additive cancer detection via a liquid biopsy multi-cancer early detection (MCED) screening test during a routine preventive care exam (PCE).MethodsPatients with incident breast cancer were identified from five years of longitudinal Blue Health Intelligence® (BHI®) claims data (2014-19) and their screening mammogram and PCE utilization were characterized. Ordinal logistic regression analyses were performed to identify the association of a biennial screening mammogram with stage at diagnosis. Additional screening opportunities for breast cancer during a PCE within two years before diagnosis were identified, and the method extrapolated to all cancers, including those without recommended screening modalities.ResultsClaims for biennial screening mammograms and the time from screening to diagnosis were found to be predictors of breast cancer stage at diagnosis. When compared to women who received a screening mammogram proximal to their breast cancer diagnosis (0-4 months), women who were adherent to guidelines but had a longer time window from their screening mammogram to diagnosis (4-24 months) had a 87% increased odds of a later-stage (stages III or IV) breast cancer diagnosis (p-value <0.001), while women with no biennial screening mammogram had a 155% increased odds of a later-stage breast cancer diagnosis (p-value <0.001). This highlights the importance of screening in the earlier detection of breast cancer. Of incident breast cancer cases, 23% had no evidence of a screening mammogram in the two years before diagnosis. However, 49% of these women had a PCE within that time. Thus, an additional 11% of breast cancer cases could have been screened if a MCED test had been available during a PCE. Additionally, MCED tests have the potential to target up to 58% of the top 5 cancers that are the leading causes of cancer death currently without a USPSTF recommended screening modality (prostate, pancreatic, liver, lymphoma, and ovarian cancer).ConclusionThe study used claims data to demonstrate the association of cancer screening with cancer stage at diagnosis and demonstrates the unmet potential for a MCED screening test which could be ordered during a PCE.

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“…For example, integrated data allow the inclusion of important clinical factors when analyzing health care utilization and costs, as recorded in claims [13]. Such integrated observational data sets have also been used to generate predictive algorithms to better identify patients with cancer [14][15][16][17] and their disease characteristics [18][19][20].…”

Section: Introductionmentioning

confidence: 99%

Data Integration to Improve Real-world Health Outcomes Research for Non–Small Cell Lung Cancer in the United States: Descriptive and Qualitative Exploration

et al. 2021

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Background The integration of data from disparate sources could help alleviate data insufficiency in real-world studies and compensate for the inadequacies of single data sources and short-duration, small sample size studies while improving the utility of data for research. Objective This study aims to describe and evaluate a process of integrating data from several complementary sources to conduct health outcomes research in patients with non–small cell lung cancer (NSCLC). The integrated data set is also used to describe patient demographics, clinical characteristics, treatment patterns, and mortality rates. Methods This retrospective cohort study integrated data from 4 sources: administrative claims from the HealthCore Integrated Research Database, clinical data from a Cancer Care Quality Program (CCQP), clinical data from abstracted medical records (MRs), and mortality data from the US Social Security Administration. Patients with lung cancer who initiated second-line (2L) therapy between November 01, 2015, and April 13, 2018, were identified in the claims and CCQP data. Eligible patients were 18 years or older and received atezolizumab, docetaxel, erlotinib, nivolumab, pembrolizumab, pemetrexed, or ramucirumab in the 2L setting. The main analysis cohort included patients with claims data and data from at least one additional data source (CCQP or MR). Patients without integrated data (claims only) were reported separately. Descriptive and univariate statistics were reported. Results Data integration resulted in a main analysis cohort of 2195 patients with NSCLC; 2106 patients had CCQP and 407 patients had MR data. The claims-only cohort included 931 eligible patients. For the main analysis cohort, the mean age was 62.1 (SD 9.27) years, 48.56% (1066/2195) were female, the median length of follow-up was 6.8 months, and for 37.77% (829/2195), death was observed. For the claims-only cohort, the mean age was 66.6 (SD 12.69) years, 52.1% (485/931) were female, the median length of follow-up was 8.6 months, and for 29.3% (273/931), death was observed. The most frequent 2L treatment was immunotherapy (1094/2195, 49.84%), followed by platinum-based regimens (472/2195, 21.50%) and single-agent chemotherapy (441/2195, 20.09%); mean duration of 2L therapy was 5.6 (SD 4.9, median 4) months. We describe challenges and learnings from the data integration process, and the benefits of the integrated data set, which includes a richer set of clinical and outcome data to supplement the utilization metrics available in administrative claims. Conclusions The management of patients with NSCLC requires care from a multidisciplinary team, leading to a lack of a single aggregated data source in real-world settings. The availability of integrated clinical data from MRs, health plan claims, and other sources of clinical care may improve the ability to assess emerging treatments.

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Leveraging Linkage of Cohort Studies With Administrative Claims Data to Identify Individuals With Cancer

Cited by 24 publications

References 15 publications

Serious Illness and End‐of‐Life Treatments for Nurses Compared with the General Population

Serious Illness and End‐of‐Life Treatments for Nurses Compared with the General Population

Association of Breast Cancer Screening Behaviors With Stage at Breast Cancer Diagnosis and Potential for Additive Multi-Cancer Detection via Liquid Biopsy Screening: A Claims-Based Study

Data Integration to Improve Real-world Health Outcomes Research for Non–Small Cell Lung Cancer in the United States: Descriptive and Qualitative Exploration

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