Analysis of a claims database for the identification of patients with carcinoma of the breast
Rent the article at a discountRent now
* Final gross prices may vary according to local VAT.Get Access
To develop and optimize algorithms for the identification of newly diagnosed and treated cases of women with carcinoma of the breast, an analysis was performed of cases identified from the claims database of a large health maintenance organization (U.S. Healthcare). An initial algorithm was developed from the patterns of claims which suggested common clinical presentations of carcinoma of the breast, and the positive predictive value was 88% (411/469). To attempt to improve upon the positive predictive value, multiple modifications of the initial algorithm were performed. The best identified modification of the initial algorithm yielded a positive predictive value of 93% (400/432) with a loss of only 3% (11/411) of the true positive cases. These results demonstrate that logic-based algorithms can be used as a valid and efficient method of identifying large numbers of cases from claims data with specific clinical characteristics. The best algorithm identified provides a powerful and accurate tool to perform health care analysis and research on large populations of women with newly diagnosed and treated carcinoma of the breast.
- Kosecoff, J., Fink, A., Brook, R.H., and Chassin, M.R., The appropriateness of using a medical procedure: Is information in the medical record valid?Med. Care 25:196–201, 1987.
- Roos, L.L., Cageorge, S.M., Austen, E., and Lohr, K.N., Using computers to identify complications after surgery.Am. J. Public Health 75:1288–1295, 1985.
- Roos, L.L., Cageorge, S.M., Roos, N.P., and Danzinger, R., Centralization, certification, and monitoring: Readmissions and complications after surgery.Med. Care 24:1044–1066, 1986.
- Roos, L.L., Sharp, S.M., and Wajda, A., Assessing data quality: A computerized approach.Social Sci. Med. 28:175–182, 1989.
- Roos, L.L., Wajda, A., Sharp, S.M., and Nicol, J.P., Software for health care analysts: A modular approach.J. Med. Syst. 11:445–464, 1987.
- Wennberg, J.E., Roos, N., Sola, L., Schori, A., and Jaffe, R., Use of claims data systems to evaluate health care outcomes: Mortality and reoperation following prostatectomy.J. Am. Med. Assoc. 257:933–936, 1987.
- Long, S.H., Gibbs, J.O., Crozier, J.P., Cooper, D.I., Newman, J.F., and Larsen, A.M., Medical expenditures of terminal cancer patients during the last year of life.Inquiry 21:315–327, 1984.
- Spector, W.D., and Mor, V., Utilization and charges for terminal cancer patients in Rhode Island.Inquiry 21:328–337, 1984.
- U.S. Department of Health and Human Services, Public Health Service, Health Care Financing Administration. ICD-9-CM: The International Classification of Diseases. 9th revision: Clinical modification. Third edition. Washington, D.C.: U.S. Government Printing Office, 1989, DHHS Publication No. (PHS) 89-1260.
- Current Procedural Terminology. Fourth edition. American Medical Association, Chicago, Illinois, 1991.
- Fowble, B., Goodman, R.L., Glick, J.H., and Rosato, E.F. (eds.),Breast cancer treatment: A comprehensive guide to management. Mosby Year Book, St. Louis, MO, 1991.
- Harris, J.R., Morrow, M., and Bonadonna, G. Cancer of the breast. In:Cancer: Principles and Practice of Oncology (fourth edition), DeVita, V.T., Hellman, S., Rosenberg, S.A. (Eds.). J.B. Lippincott Company, Philadelphia, PA, pp. 1264–1332, 1993.
- Nattinger, A.B., Gottlieb, M.S., Veum, J., Yahnke, D., and Goodwin, J.S. Geographic variation in the use of breast-conserving treatment of breast cancer.New Engl. J. Med. 326:1102–1107, 1992.
- Farrow, D.C., Hunt, W.C., and Samet, J.M., Geographic variation in the treatment of localized breast cancer.New Engl. J. Med. 326:1097–1101, 1992.
- Bright, R.A., Avorn, J., and Everitt, D.E., Medicaid data as a resource for epidemiologic studies: Strengths and limitations.J. Clin. Epidemiol. 42:937–945, 1989.
- Lohr, K.N., Use of insurance claims data in measuring quality of care.Int. J. Technol. Assess. Health Care 6:263–271, 1990.
- Steinberg, E.P., Whittle, J., and Anderson, G.F., The impact of claims data research on clinical practice.Int. J. Technol. Assess. Health Care 6:282–287, 1990.
- Weiner, J.P., Powe, N.R., Steinwachs, D.M., and Dent, G., Applying insurance claims data to assess quality of care: A compilation of potential indicators.Quality Rev. Bull. 16:424–438, 1990.
- Hsia, D.C., Krushat, W.M., Fagan, A.B., Tebbutt, J.A., and Kusserow, R.P., Accuracy of diagnostic coding for Medicare patients under the prospective-payment system.New Engl. J. Med. 318:352–355, 1988.
- Analysis of a claims database for the identification of patients with carcinoma of the breast
Journal of Medical Systems
Volume 18, Issue 1 , pp 23-32
- Cover Date
- Print ISSN
- Online ISSN
- Kluwer Academic Publishers-Plenum Publishers
- Additional Links
- Industry Sectors
- Author Affiliations
- 1. From the Department of Radiation Oncology, the University of Pennsylvania School of Medicine, 19104, Philadelphia, Pennsylvania
- 2. U.S. Healthcare, 19422, Blue Bell, Pennsylvania
- 3. Department of Mathematics, Millersville University, 17551, Millersville, PA
- 4. the University of Pennsylvania Cancer Center, 19104, Philadelphia, Pennsylvania