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Colorectal Cancer Identification Methods Among Kansas Medicare Beneficiaries, 2008-2010.

Lai SM, Jungk J, Garimella S - Prev Chronic Dis (2015)

Bottom Line: Factors associated with screening/surveillance-identified CRC were analyzed using logistic regression.Younger age at diagnosis (65 to 74 years) was the only factor associated with having screening/surveillance-identified CRC in multivariable analysis.Combining administrative claims data with population-based registry records can offer novel insights into patterns of CRC test use and identification methods among people diagnosed with CRC.

View Article: PubMed Central - PubMed

Affiliation: Kansas Cancer Registry, Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS 66160-7313. Email: slai@kumc.edu.

ABSTRACT

Introduction: Population-based data are limited on how often colorectal cancer (CRC) is identified through screening or surveillance in asymptomatic patients versus diagnostic workup for symptoms. We developed a process for assessing CRC identification methods among Medicare-linked CRC cases from a population-based cancer registry to assess identification methods (screening/surveillance or diagnostic) among Kansas Medicare beneficiaries.

Methods: New CRC cases diagnosed from 2008 through 2010 were identified from the Kansas Cancer Registry and matched to Medicare enrollment and claims files. CRC cases were classified as diagnostic-identified versus screening/surveillance-identified using a claims-based algorithm for determining CRC test indication. Factors associated with screening/surveillance-identified CRC were analyzed using logistic regression.

Results: Nineteen percent of CRC cases among Kansas Medicare beneficiaries were screening/surveillance-identified while 81% were diagnostic-identified. Younger age at diagnosis (65 to 74 years) was the only factor associated with having screening/surveillance-identified CRC in multivariable analysis. No association between rural/urban residence and identification method was noted.

Conclusion: Combining administrative claims data with population-based registry records can offer novel insights into patterns of CRC test use and identification methods among people diagnosed with CRC. These techniques could also be extended to other screen-detectable cancers.

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Related in: MedlinePlus

Identification method classification process and results for invasive colorectal cancer (CRC), Kansas Medicare beneficiaries, 2008–2010. “Ko algorithm” refers to classification and regression tree algorithm for colonoscopy indication (diagnostic vs average-risk screening/high-risk screening/surveillance) developed by Ko et al (10).
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Figure 1: Identification method classification process and results for invasive colorectal cancer (CRC), Kansas Medicare beneficiaries, 2008–2010. “Ko algorithm” refers to classification and regression tree algorithm for colonoscopy indication (diagnostic vs average-risk screening/high-risk screening/surveillance) developed by Ko et al (10).

Mentions: CRC identification method (screening/surveillance vs diagnostic) was determined by evaluating the indication for use of any CRC-related tests (colonoscopy, computed tomography [CT] colonography, double-contrast barium enema, fecal occult blood test [FOBT]/fecal immunochemical test [FIT], sigmoidoscopy) documented in Medicare claims during the 60 days before diagnosis. Because CRC screening and surveillance are test-based, patients without a CRC-related test in the 60-day window were assumed to be diagnostic-identified (n = 256). Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify CRC-related tests on claims from physician encounters, hospital outpatient encounters, and inpatient admissions (Table 1). For patients who had a colonoscopy claim in the 60-day window (n = 1,257), the nonparametric classification and regression tree (CART) algorithm for 2-level colonoscopy indication (diagnostic vs average-risk screening/high-risk screening/surveillance) developed by Ko et al was applied to determine colonoscopy indication and corresponding CRC identification method (10). The CART algorithm uses ICD-9-CM diagnosis codes from the colonoscopy claim and claims during the year before to determine indication and does not rely on specific colonoscopy procedure codes. The sensitivity and specificity for this algorithm were reported as 77% and 90%, respectively, by the authors (10). For patients who did not have a colonoscopy in the 60-day window but did have another CRC-related test (CT colonography, double-contrast barium enema, FOBT/FIT, sigmoidoscopy) (n = 294), claims from the year before the test date were examined for CRC symptom ICD-9-CM diagnosis codes (Table 1). Among this group, patients with 1 or more claims with a CRC symptom diagnosis code were classified as diagnostic-identified. The Figure summarizes the CRC identification classification results for all patients.


Colorectal Cancer Identification Methods Among Kansas Medicare Beneficiaries, 2008-2010.

Lai SM, Jungk J, Garimella S - Prev Chronic Dis (2015)

Identification method classification process and results for invasive colorectal cancer (CRC), Kansas Medicare beneficiaries, 2008–2010. “Ko algorithm” refers to classification and regression tree algorithm for colonoscopy indication (diagnostic vs average-risk screening/high-risk screening/surveillance) developed by Ko et al (10).
© Copyright Policy
Related In: Results  -  Collection

Show All Figures
getmorefigures.php?uid=PMC4509094&req=5

Figure 1: Identification method classification process and results for invasive colorectal cancer (CRC), Kansas Medicare beneficiaries, 2008–2010. “Ko algorithm” refers to classification and regression tree algorithm for colonoscopy indication (diagnostic vs average-risk screening/high-risk screening/surveillance) developed by Ko et al (10).
Mentions: CRC identification method (screening/surveillance vs diagnostic) was determined by evaluating the indication for use of any CRC-related tests (colonoscopy, computed tomography [CT] colonography, double-contrast barium enema, fecal occult blood test [FOBT]/fecal immunochemical test [FIT], sigmoidoscopy) documented in Medicare claims during the 60 days before diagnosis. Because CRC screening and surveillance are test-based, patients without a CRC-related test in the 60-day window were assumed to be diagnostic-identified (n = 256). Current Procedural Terminology (CPT), Healthcare Common Procedure Coding System (HCPCS), and International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure codes were used to identify CRC-related tests on claims from physician encounters, hospital outpatient encounters, and inpatient admissions (Table 1). For patients who had a colonoscopy claim in the 60-day window (n = 1,257), the nonparametric classification and regression tree (CART) algorithm for 2-level colonoscopy indication (diagnostic vs average-risk screening/high-risk screening/surveillance) developed by Ko et al was applied to determine colonoscopy indication and corresponding CRC identification method (10). The CART algorithm uses ICD-9-CM diagnosis codes from the colonoscopy claim and claims during the year before to determine indication and does not rely on specific colonoscopy procedure codes. The sensitivity and specificity for this algorithm were reported as 77% and 90%, respectively, by the authors (10). For patients who did not have a colonoscopy in the 60-day window but did have another CRC-related test (CT colonography, double-contrast barium enema, FOBT/FIT, sigmoidoscopy) (n = 294), claims from the year before the test date were examined for CRC symptom ICD-9-CM diagnosis codes (Table 1). Among this group, patients with 1 or more claims with a CRC symptom diagnosis code were classified as diagnostic-identified. The Figure summarizes the CRC identification classification results for all patients.

Bottom Line: Factors associated with screening/surveillance-identified CRC were analyzed using logistic regression.Younger age at diagnosis (65 to 74 years) was the only factor associated with having screening/surveillance-identified CRC in multivariable analysis.Combining administrative claims data with population-based registry records can offer novel insights into patterns of CRC test use and identification methods among people diagnosed with CRC.

View Article: PubMed Central - PubMed

Affiliation: Kansas Cancer Registry, Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Mail Stop 1008, 3901 Rainbow Blvd, Kansas City, KS 66160-7313. Email: slai@kumc.edu.

ABSTRACT

Introduction: Population-based data are limited on how often colorectal cancer (CRC) is identified through screening or surveillance in asymptomatic patients versus diagnostic workup for symptoms. We developed a process for assessing CRC identification methods among Medicare-linked CRC cases from a population-based cancer registry to assess identification methods (screening/surveillance or diagnostic) among Kansas Medicare beneficiaries.

Methods: New CRC cases diagnosed from 2008 through 2010 were identified from the Kansas Cancer Registry and matched to Medicare enrollment and claims files. CRC cases were classified as diagnostic-identified versus screening/surveillance-identified using a claims-based algorithm for determining CRC test indication. Factors associated with screening/surveillance-identified CRC were analyzed using logistic regression.

Results: Nineteen percent of CRC cases among Kansas Medicare beneficiaries were screening/surveillance-identified while 81% were diagnostic-identified. Younger age at diagnosis (65 to 74 years) was the only factor associated with having screening/surveillance-identified CRC in multivariable analysis. No association between rural/urban residence and identification method was noted.

Conclusion: Combining administrative claims data with population-based registry records can offer novel insights into patterns of CRC test use and identification methods among people diagnosed with CRC. These techniques could also be extended to other screen-detectable cancers.

Show MeSH
Related in: MedlinePlus