An algorithm for the use of medicare claims data to identify women with incident breast cancer

Ann B. Nattinger, Purushottam W. Laud, Ruta Bajorunaite, Rodney A. Sparapani, Jean L. Freeman

Research output: Contribution to journalArticle

134 Citations (Scopus)

Abstract

Objective. To develop and validate a clinically informed algorithm that uses solely Medicare claims to identify, with a high positive predictive value, incident breast cancer cases. Data Source. Population-based Surveillance, Epidemiology, and End Results (SEER) Tumor Registry data linked to Medicare claims, and Medicare claims from a 5 percent random sample of beneficiaries in SEHR areas. Study Design. An algorithm was developed using claims from 1995 breast cancer patients from the SEER-Medicare database, as well as 1995 claims from Medicare control subjects. The algorithm was validated on claims from breast cancer subjects and controls from 1994. The algorithm development process used both clinical insight and logistic regression methods. Data Extraction. Training set: Claims from 7,700 SEER-Medicare breast cancer subjects diagnosed in 1995, and 124,884 controls. Validation set: Claims from 7,607 SEER-Medicare breast cancer subjects diagnosed in 1994, and 120,317 controls. Principal Findings. A four-step prediction algorithm was developed and validated. It has a positive predictive value of 89 to 93 percent, and a sensitivity of 80 percent for identifying incident breast cancer. The sensitivity is 82-87 percent for stage I or II, and lower for other stages. The sensitivity is 82-83 percent for women who underwent either breast-conserving surgery or mastectomy, and is similar across geographic sites. A cohort identified with this algorithm will have 89-93 percent incident breast cancer cases, 1.5-6 percent cancer-free cases, and 4-5 percent prevalent breast cancer cases. Conclusions. This algorithm has better performance characteristics than previously proposed algorithms. The ability to examine national patterns of breast cancer care using Medicare claims data would open new avenues for the assessment of quality of care.

Original languageEnglish (US)
Pages (from-to)1733-1749
Number of pages17
JournalHealth Services Research
Volume39
Issue number6 I
StatePublished - Dec 2004

Fingerprint

Medicare
incident
cancer
Breast Neoplasms
epidemiology
Epidemiology
surveillance
Population Surveillance
Segmental Mastectomy
Quality of Health Care
Information Storage and Retrieval
Mastectomy
Registries
random sample
Neoplasms
surgery
Logistic Models
Databases
logistics
regression

Keywords

  • Breast neoplasm
  • Incidence
  • Medicare
  • Registries
  • Sensitivity and specificity

ASJC Scopus subject areas

  • Nursing(all)
  • Health(social science)
  • Health Professions(all)
  • Health Policy

Cite this

Nattinger, A. B., Laud, P. W., Bajorunaite, R., Sparapani, R. A., & Freeman, J. L. (2004). An algorithm for the use of medicare claims data to identify women with incident breast cancer. Health Services Research, 39(6 I), 1733-1749.

An algorithm for the use of medicare claims data to identify women with incident breast cancer. / Nattinger, Ann B.; Laud, Purushottam W.; Bajorunaite, Ruta; Sparapani, Rodney A.; Freeman, Jean L.

In: Health Services Research, Vol. 39, No. 6 I, 12.2004, p. 1733-1749.

Research output: Contribution to journalArticle

Nattinger, AB, Laud, PW, Bajorunaite, R, Sparapani, RA & Freeman, JL 2004, 'An algorithm for the use of medicare claims data to identify women with incident breast cancer', Health Services Research, vol. 39, no. 6 I, pp. 1733-1749.
Nattinger AB, Laud PW, Bajorunaite R, Sparapani RA, Freeman JL. An algorithm for the use of medicare claims data to identify women with incident breast cancer. Health Services Research. 2004 Dec;39(6 I):1733-1749.
Nattinger, Ann B. ; Laud, Purushottam W. ; Bajorunaite, Ruta ; Sparapani, Rodney A. ; Freeman, Jean L. / An algorithm for the use of medicare claims data to identify women with incident breast cancer. In: Health Services Research. 2004 ; Vol. 39, No. 6 I. pp. 1733-1749.
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