Measurement of Colorectal Cancer Test Use With Medical Claims Data in a Safety-Net Health System

Abstract

Background Optimizing colorectal cancer (CRC) screening requires identification of unscreened individuals, and tracking screening trends. A recent NIH State of the Science Conference, “Enhancing Use and Quality of CRC Screening,” cited a need for more population data sources for measurement of CRC screening, particularly for the medically underserved. Medical claims data (claims data) are created and maintained by many health systems to facilitate billing for services rendered, and may be an efficient resource for identifying unscreened individuals. The aim of our study, conducted at a safety-net health system, was to determine whether CRC test use measured by claims data matches medical chart documentation. Methods We randomly selected 400 patients from a universe of 20,000 patients previously included in an analysis of CRC test use based on claims data 2002–2006 in Tarrant Co, TX. Claims data were compared with medical chart documentation by estimation of agreement and examination of test use over-/under-documentation. Results We found agreement on test use was very good for fecal occult blood testing (κ=0.83, 95% CI:0.75–0.90) and colonoscopy (κ=0.91, 95% CI:0.85–0.96), and fair for sigmoidoscopy (κ=0.39, 95% CI:0.28–0.49). Over- and under-documentation of the two most commonly used CRC tests―colonoscopy and FOBT―were rare. Conclusion Use of claims data by health systems to measure CRC test use is a promising alternative to measuring CRC test use with medical chart review, and may be used to identify unscreened patients for screening interventions, and track screening trends over time.

Patients’ Perceptions of Colorectal Cancer Screening Tests and Preparatory Education in Federally Qualified Health Centers

“…There was significant endorsement for in-clinic preparatory education as a way of empowering patients with information to increase receptivity and follow up with screening recommendations. When taken together with data from healthcare provider interviews in the FQHC setting [22] and other published literature [34, 35], our findings suggest an important opportunity to enhance patient education materials by focusing on a test-specific strategy, particularly iFOBT/FIT as an initial modality for improving screening rates among medically underserved populations in FQHCs. Participants also preferred clearly communicated, easy-to-understand health education materials.…”

Geographic and population-level disparities in colorectal cancer testing: A multilevel analysis of Medicaid and commercial claims data

“…Claims data include all healthcare encounters that generate a billing claim for enrolled members over specific time periods. Claims data have been used to understand cancer screening patterns in diverse insured populations (Wheeler et al, 2014; Ko et al, 2002; Ko et al, 2005; Koroukian et al, 2005; O'Malley et al, 2005; Schenck et al, 2009; Gupta et al, 2013a; Schenck et al, 2007). The National Institutes of Health (NIH) recently cited a need for more population data sources for measurement of CRC testing, particularly for the medically underserved (Steinwachs et al, 2010; Gupta et al, 2013a).…”

“…Claims data have been used to understand cancer screening patterns in diverse insured populations (Wheeler et al, 2014; Ko et al, 2002; Ko et al, 2005; Koroukian et al, 2005; O'Malley et al, 2005; Schenck et al, 2009; Gupta et al, 2013a; Schenck et al, 2007). The National Institutes of Health (NIH) recently cited a need for more population data sources for measurement of CRC testing, particularly for the medically underserved (Steinwachs et al, 2010; Gupta et al, 2013a). In contrast to patient self-reported cancer screening practices, which may be unreliable or inaccurate due to recall bias and social desirability bias, claims data can provide an objective assessment of cancer screening behaviors in a specific population (Schenck et al, 2007; Dodou and de Winter, 2015; Bradbury et al, 2005).…”

Health plan adaptations to a mailed outreach program for colorectal cancer screening among Medicaid and Medicare enrollees: the BeneFIT study

“…Both health plans also made adaptations to improve the identification of enrollees. While past research has shown that claims data can accurately identify prior CRC screening [ 21 ], our study identified additional aspects of patient identification that are necessary for a successful mailed FIT intervention: accurate contact information, and information about whether enrollees had established care at a given health center.…”