title: Defining care provided for breast cancer based on medical record review or Medicare claims: information from the Centers for Disease Control and Prevention Patterns of Care Study.
abstract: BACKGROUND
  Description of care patterns is important as evidence-based guidelines increasingly dictate care. We explore the level of agreement between claims and record abstraction for guideline concordant multidisciplinary breast cancer care.
  
  
  METHODS
  From the U.S. Centers for Disease Control and Prevention's National Program of Cancer Registries Patterns of Care study, in which medical record abstraction of breast cancer and treatment was accomplished, cases include breast cancer where Medicare claims were available. Components of care were breast-conserving surgery (BCS), mastectomy, node assessment, radiation (RT), and chemotherapy (CTX), including specific chemotherapeutic agents, and combinations. We compared Medicare claims with record abstraction, and measured concordance using the kappa statistic and sensitivity.
  
  
  RESULTS
  The study sample consisted of 1762 women with stage 0 to 4 breast cancer. Level of agreement was excellent for surgery type (kappa = 0.84) and CTX (kappa = 0.89); agreement for RT therapy was slightly lower (kappa = 0.79). For standard multicomponent strategies, sensitivities and specificities were high; for example, 88.8%/93.5% for mastectomy plus nodes and 86.6%/95.4% for BCS plus nodes and RT. For selected, standard, multi-agent, adjuvant CTX regimens, sensitivities ranged from 66.3% to 68.8% (kappa 0.63-0.73).
  
  
  CONCLUSIONS
  Medicare claims, compared with chart abstraction, is a reliable method for determining patterns of multicomponent care for breast cancer.
authors.affiliation: University of Kentucky College of Public Health, Lexington, USA. stflem2@uky.edu
authors.forename: Steven T
authors.initials: ST
authors.lastname: Fleming
authors.forename: Gretchen G
authors.initials: GG
authors.lastname: Kimmick
authors.forename: Susan A
authors.initials: SA
authors.lastname: Sabatino
authors.forename: Rosemary D
authors.initials: RD
authors.lastname: Cress
authors.forename: Xiao-Cheng
authors.initials: XC
authors.lastname: Wu
authors.forename: Amy
authors.initials: A
authors.lastname: Trentham-Dietz
authors.forename: Bin
authors.initials: B
authors.lastname: Huang
authors.forename: Wenke
authors.initials: W
authors.lastname: Hwang
authors.forename: Jonathan M
authors.initials: JM
authors.lastname: Liff
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000970:Antineoplastic Agents / Q000627:therapeutic use; D001943:Breast Neoplasms / Q000628:therapy*; D002487:Centers for Disease Control and Prevention, U.S.; D003131:Combined Modality Therapy; D003430:Cross-Sectional Studies; D005260:Female; D019538:Health Care Surveys; D006801:Humans; D007345:Insurance Claim Review / Q000706:statistics & numerical data*; D008408:Mastectomy / Q000706:statistics & numerical data; D008498:Medical Record Linkage; D008499:Medical Records / Q000706:statistics & numerical data*; D006278:Medicare / Q000706:statistics & numerical data*; D008875:Middle Aged; D010818:Practice Patterns, Physicians'; D015995:Prevalence; D011785:Quality Assurance, Health Care / Q000706:statistics & numerical data*; D012042:Registries; D012680:Sensitivity and Specificity; D014481:United States / Q000453:epidemiology
chemical_list: D000970:Antineoplastic Agents