bluuebunny/crossref_metadata_2025_split huggingface dataset:
Assessing the validity of using claims data compared to medical chart reviews for measuring care quality in Japan.
Authors: Nakamoto Nana , Nakamura Fumiaki , Higashi Takahiro , Iwamoto Momoko , Amano Asuka , Hirayasu Masako , Higa Hatsue , Asato Kuniko , Aoki Kazuo , Masuda Masato 
Published: February 2017

264 Background: Health insurance claims data have been used extensively as a less labor-intensive method of collecting data than medical record reviews, which are the preferred source of data collection in most medical studies. Although recent reports have raised questions about its validity of use in measuring care quality, validity of using claims data may differ by health systems and should therefore be assessed by country. We aimed to test the validity of using claims data in Japan by comparing quality performance scores obtained from claims data to those derived from medical record reviews. Methods: We reviewed medical records from Apr 2013 to Apr 2014 of gastric and colorectal cancer patients who were diagnosed in 2011 from 4 cancer care hospitals in Okinawa. We calculated the proportion of patients who received adjuvant chemotherapy for gastric and colorectal cancer using claims data, and compared the results with those obtained from medical record reviews. Chart reviews were performed by certified tumor registrars. We used kappa coefficients to measure the level of agreement between claims data and medical record reviews. Results: Analysis using claims data resulted in 14 Stage II and III gastric cancer patients who had undergone surgery, with 50% receiving adjuvant chemotherapy; whereas medical record reviews resulted in 19 patients, 94.7% of whom either received or had a clinically valid rationale for not undergoing adjuvant therapy. For colorectal patients, claims data resulted in 48.5% of 68 surgical stage III colorectal patients receiving adjuvant therapy, compared to 74.4% of 78 patients using medical record reviews who either received adjuvant therapy or had a valid reason for not undergoing therapy. Agreement between claims data and chart reviews was low (kappa=0.14) for gastric cancer, but fair (kappa =0.37) for colorectal cancer. Conclusions: Our analysis showed that use of claims data may greatly underestimate quality performance measures if they are not compensated by medical record reviews. Claims data alone cannot capture a large proportion of patients who either choose not to, or has a clinically valid reason for not undergoing standard care.
Reporting on quality indicators in renal cell carcinoma: Proportion of metastatic patients who initially commence on full-dose targeted therapy.
Authors: Wood Lori , Heng Daniel Yick Chin , Knox Jennifer J. , Bjarnason Georg A. , Kollmannsberger Christian K. , Kapoor Anil , Hotte Sebastien J. , Vanhuyse Marie , Czaykowski Piotr , Soulieres Denis , Finelli Antonio , Liu Zhihui 
Published: February 2017

265 Background: Measuring quality of care is required to improve patient outcomes. There are 23 established Quality Indicators in Renal Cell Carcinoma (RCC) (Wood LA et al, JOP 2013) including initiating targeted therapy (TT) at full dose. It is recognized that the dose of TT is important to optimize clinical outcomes. Methods: The Canadian Kidney Cancer Information System (CKCis) is a prospectively maintained database of RCC pts from 14 Canadian academic centers. CKCis data was used to determine the use of TT in metastatic pts, the initial dose in the first line setting, and factors influencing whether pts initiated full dose TT. Descriptive statistics were performed to characterize current practices and a multivariate logistic regression was performed to assess predictors of initiating full dose TT. Results: Between 2006 and 2014, 560 pts received first-line TT and make up the study cohort. 92% received VEGF TT (81% sunitinib; 9% pazopanib; 2% sorafenib) and 8% received mTOR TT (5% everolimus; 3% temsirolimus). All pts receiving mTOR inhibitors received full dose and are excluded from further analysis. Full dose VEGF TT was initiated in 87% on sunitinib, 78% on pazopanib, and 92% on sorafenib. The sunitinib schedule was 4/2 in 81%, 2/1 in 12%, and other in 7%. Pts were less likely to initiate full dose TT if they were older (OR: 1.10, 95% CI 1.06-1.15), female (OR: 2.23, 95% CI 1.09-4.55) or had a worse ECOG PS (2,3,4 vs 0,1) (OR: 2.30, 95% CI 0.95-5.59). Data on initial versus final dose of TT will also be presented. Conclusions: Maximizing exposure to TT is important in metastatic RCC which is why initiating full dose TT was prioritized as a key QI in RCC. In this study, 87% of pts were initiated on full dose VEGF TT in the first line setting, and 100% of pts on mTOR TT which is higher than predicted. Those less likely to start on full dose VEGF TT were older, female and had a lower ECOG PS. The gender discrepancy will be explored in future studies.
Linking commercial claims and state registry data to assess cancer care quality at the medical group level: Early lessons from California.
Authors: Woo Ann , Foley Kathleen A. 
Published: February 2017

269 Background: The Integrated Healthcare Association (IHA) is a non-profit organization which runs the largest Pay for Performance program in California. We describe a feasibility study to apply NQF cancer quality measures to linked commercial claims and state registry data and calculate results at the physician organization level. We describe phase I of the study: identifying appropriate measures and securing access to the data. Methods: We requested technical specifications for 9 NQF breast and colon cancer quality measures from the measure stewards and 2009 –2012 claims data from 7 California health plans. Results: Two barriers were identified in phase I: First, California Cancer Registry (CCR) data policies, designed for public health surveillance and not quality measurement, caused delays and present hurdles to public reporting. CCR data is not available until it is at least 95% complete, so 2011 data was not available until October 2013. Moreover, CCR requires that they conduct the data linkage, which required new data use agreements between the data aggregator and each participating insurer – costly in both time and legal fees. Finally, obstacles to public reporting any of the CCR data at the provider level still exist. Barrier 2: NQF measure specifications for linked claims-registry data sets do not currently exist, so the project team developed them, adding to the problem of proliferating non-harmonized quality measures. Conclusions: While the application of NQF measures to claims-registry linkage appears feasible for measurement of cancer care quality at the medical group level, registry policies and the lack of standard technical specifications for linked claims-registry data sets adversely impact the timeliness, usability, and comparability of results using two widely available data sources. More flexible policies on the part of data registries and attention to measure harmonization could improve data quality and usability for cancer care quality assessment and public reporting, and should be considered. In phase 2, we will apply the measures at the physician group level, and assess the feasibility of public reporting at the physician group level.
Overall survival and complications of cancer therapy in HIV-positive cancer patients on HAART compared to HIV-negative cancer patients.
Authors: Fritz Kelly Ann , Stenehjem David D. , Sanders Stephanie A. , Cohen Adam Louis 
Published: February 2017

276 Background: HIV-positive patients are living longer and are at higher risk for any type of cancer, not only traditional AIDS-defining cancers (ADC). This study aims to assess our overall survival rate in HIV-positive cancer patients compared to HIV-negative patients, and identify differences in complications of cancer therapy in order to ensure quality of care and outcomes in this patient population. Methods: HIV-positive patients ≥ 18 years of age with a diagnosis of cancer in the Huntsman Cancer Institute Tumor Registry from 2008-2013 were matched to HIV-negative cancer patients by cancer type, stage, age, and sex. Overall survival (OS), admission for febrile neutropenia (FN), total hospital length (LOS) of stay for any reason, and the total number of blood transfusions were assessed. Kaplan-Meier methodology was used to assess differences in cancer survival. Results: A total of 55 HIV-positive patients and 40 HIV-negative patients were included. HIV-positive patients were younger at cancer diagnosis than HIV-negative patients, 50 vs. 56 years old (p = 0.0017). A trend for reduced median OS in HIV-positive patients was observed compared to HIV-negative patients (HR 1.81; 95% CI 0.77-4.71; p = 0.1835). One-year OS was 78% for HIV-positive vs 88% for HIV-negative patients (p = 0.2673). Numerically an increased mean number of hospital admissions for FN (0.7 ± 2.0 vs. 0.4 ± 1.3; p = 0.2663), transfusions (2.5 ± 12.7 vs. 0.9 ± 2.5; p = 0.4907), and inpatient LOS (12.7 ± 23.6 vs. 7.0 ± 13.0; p = 0.2381) were observed in the HIV-positive group compared to the HIV-negative group, however this did not meet statistical significance. Conclusions: This retrospective study highlights a trend for a reduction in survival and increased FN admissions, LOS and transfusion requirements in HIV-positive patients with cancer. We have identified a need for improvement in supportive care treatments such as primary febrile neutropenia prophylaxis, opportunistic infection prophylaxis, and anemia management to improve the quality of cancer treatment in this patient population.
Proof-of-concept: A working demonstration of real-time patient tracking using time-driven activity-based costing.
Authors: Jones Tiffany M. , Huang Yu-Ting , Guzman Alexis B. , DelValle-Garza Monica , Kolom Christian C. , Incalcaterra James , Feeley Thomas W. 
Published: February 2017

28 Background: Historically, hospital costs are based on a cost-to-charge ratio. The current cost system determines when a charge is filed and a bill is created, which can be days following the patient visit. This time lag between the patient visit and the billed charges can be problematic. In preparation for episode-based payments, it is essential to know the true cost of care at the time of delivery. To accomplish this goal, the University of Texas MD Anderson Cancer Center (MDACC) leveraged existing time-driven activity-based costing (TDABC) process maps to track the true costs of the patient care cycle. Methods: The first steps were to understand the patient care cycle through process mapping. Next, data sources were identified to capture patient volumes. Process maps were adjusted to capture the data sources and provide a more accurate cost. Trigger logic models were created to link data sources and the TDABC process maps to the true cost for each patient appointment. Lastly, we developed a SAS software program to compute the real-time TDABC costs for 50 patients in the Head & Neck Center. Results: Our existing data sources capture information relevant to TDABC on a regular basis. Patient appointment data provided the patient visit, and billing and time data provided approximations of the amount of time spent in the encounter and the number of resources involved in the patient visit. Out of 219 process maps, 148 (70%) were matched to existing patient appointment and charge data using the trigger logic. This allowed us to track 4,980 patient appointments for 50 patients in fifteen minutes. Conclusions: As data are collected throughout the institution, it is realized that multiple data sources are needed to reconcile the patient’s experience and to match the TDABC process maps to existing data sources. Since our data sources are updated daily and are based on a patient’s date of service, we can capture our costs of delivering care close to real-time. This process is continually refined as additional data sources are made available and as process maps are developed in other parts of MDACC.
Establishing a system to monitor and evaluate the quality of cancer care in Japan.
Authors: Iwamoto Momoko , Nakamura Fumiaki , Higashi Takahiro 
Published: February 2017

287 Background: To ensure equitable access to high-quality cancer care, efforts to routinely measure key performance indicators of cancer policy began in Japan in 2014. Although assessing the quality of cancer care is a vital component of this initiative, a system for evaluating process of care across a large number of hospitals has not yet been established. We aimed to establish this system by creating a database of health claims data linked to hospital-based cancer registry (HBCR) and measuring quality indicators (QIs) for cancer care. Methods: We created a database of 28 months (Sept10-Dec12) of health claims data linked to HBCR for 100,825 breast, prostate, colorectal, stomach, lung, liver, and cervical cancer patients who were newly diagnosed in 2011 from 178 designated cancer care hospitals in Japan. Among 206 QIs that were previously developed by a panel of experts, we measured 13 that were measureable from claims data: 1) seven QIs on adherence to guidelines on adjuvant therapy, 2) four QIs on lab tests, procedures, and medication, and 3) two QIs on supportive care. Results: QIs investigating adherence to clinical guidelines on adjuvant therapy tended to be lower compared to QIs for supportive care. For example, 48.0% [46.4, 49.6] of stage III colorectal cancer patients (n=3,638) received adjuvant chemotherapy (5FU+LV, UFT+LV, Cape, FOLFOX, or CapeOX) within 8 postoperative weeks, whereas 68.1% [67.2, 69.0] of patients (n=10,104) received three-drug combination (5HT3-r antagonist, dexamethasone, and aprepitant) before receiving highly emetogenic chemotherapy. QIs on appropriate testing and procedures were higher overall, such that 83.3% [82.6, 84.0] of invasive breast cancer patients (n=12,447) received HER2 testing. In all QIs, there was large variability in performance across hospitals. Feedback was given to hospitals through interactive webpages. Conclusions: This is the first attempt at measuring the quality of cancer care across such a large number of hospitals in Japan. Our research showed that in all QIs, there was ample room for improvement. Continuous monitoring, improving feedback methods, expansion of QIs, and application of electronic health records, will be our next challenge as we move forward in this initiative.
A decision-analytic model of idelalisib in relapsed or refractory patients with follicular lymphoma in the United States.
Authors: Smith Nathaniel , Xenakis Alexander , Beckerman Rachel , Chhatwal Jagpreet , Gregory Stephanie A. , Briggs Andrew 
Published: February 2017

30 Background: There are currently few treatment options for relapsed/refractory (RR) indolent non-Hodgkin’s lymphoma (iNHL) patients. Idelalisib (IDELA) is a first-in class PI3Kδ inhibitor with substantial clinical efficacy in iNHL patients refractory to rituximab and an alkylating agent. A single-arm clinical trial (Study 101-09) showed RR iNHL patients treated with IDELA have a median of 11 and 20.3 months of progression-free and overall survival (PFS and OS), respectively. Efficacy was also demonstrated in patients with iNHL subtypes such as follicular lymphoma (FL). The objective of this study was to project the health outcomes of IDELA versus the current standard of care for US FL patients. Methods: A partitioned survival model simulated a cohort of RR FL patients over 10 year time horizon. Patients first received IDELA or an aggregate comparator of current RR iNHL chemotherapy regimens in a progression-free state before transitioning to a progressive-disease state where they received palliative care until death. Survival data was fit and extrapolated from Study 101-09 (IDELA) for FL patients. A real-world database claims analysis provided survival, disease- and treatment-related adverse event (AEs) profiles, and medical resource utilization data for RR iNHL patients for the comparator. All outcomes were discounted at 3%. Results: Claims data predicted a median of 6.16 and 13.04 months of PFS and OS, respectively, for the comparator. Our model suggests that IDELA treatment improved health outcomes over 10 years versus the comparator, increasing life-months (LMs) and progression-free life-months (PFLMs) by 9.94 and 4.63 mos, respectively. Over 1 year, IDELA reduced both AEs and hospitalisations in FL patients by 40.3% and 49.8%, respectively. Deterministic and probabilistic sensitivity analyses demonstrated the model results are robust across different methods of survival extrapolation. Conclusions: IDELA was projected to improve health outcomes in RR FL patients compared to current treatments, largely driven by improved PFS and OS; short-term reductions in AEs and hospitalisation were specifically related to a delayed disease progression.
Personal history of atypical ductal hyperplasia and risk of multifocal breast cancer among newly diagnosed women: Implications for workup and management.
Authors: Petersen Curtis Lee , Onega Tracy 
Published: February 2017

300 Background: Multifocal breast cancer (MFBC) is associated with a higher risk of mortality than unifocal and often changes evaluation and management compared to unifocal breast cancer. Although there are known risk factors for invasive breast cancer, including atypical ductal hyperplasia (ADH), none have been explicitly associated with risk of MFBC. Our objective was to determine if there is an association between ADH and MFBC to help guide clinical decisions in workup and management in women with newly-diagnosed breast cancer. Methods: Using data (1999-2008) from the New Hampshire Mammography Network (NHMN) – a longitudinal breast imaging registry, including pathology data – we identified a cohort of 3,039 women (median age: 59) with a diagnosis of invasive or in situ breast cancer, and ascertained all prior biopsy results if applicable. We performed multivariable logistic regression to test the association of ADH with MFBC v. unifocal, adjusting for other benign breast disease, family history, breast density, age, race, and DCIS/invasive. Results: Of the 3,039 women with breast cancer during the study period, 498 had a diagnosis of ADH (16.4%) and 277 had MFBC (9.1%). Women with a history of ADH had over a two-fold greater likelihood of having MFBC compared to women without an ADH diagnosis (OR: 2.20, 95% CI: 1.61-2.99). No notable difference in this association was noted for DCIS v. invasive, and no other risk factors were found to have a significant difference, except for number of biopsies. Conclusions: We found that ADH diagnosis is positively associated with MFBC among women with a diagnosed invasive or in situ breast cancer. Our results suggest that among women with a newly diagnosed breast cancer, history of an ADH diagnosis increases the pre-test probability of MFBC, which may influence evaluation of extent of disease, such as adding breast MRI, and ultimately in treatment and management.
Evaluation of health care resource utilization (HRU) in real-world patients treated for chronic lymphocytic leukemia (CLL).
Authors: Feinberg Bruce A. , Schenkel Brad , McBride Ali , Ellis Lorie , Radtchenko Janna 
Published: February 2017

302 Background: Elucidating healthcare resource utilization (HRU) in real-world clinical practice is essential in understanding the economic burden of a disease. The objective of this study was to evaluate HRU in treated CLL patients. Methods: Using proprietary MORE Registry Research Edition claims, patients treated with antineoplastics for CLL identified by ICD-9 codes during a 48-month period (August 2009-2013) were selected. Patients who were pregnant or <18 years of age, or were treated for secondary malignancies were excluded. Descriptive statistics were used to analyze HRU primarily focused on hospitalizations, office visits, and emergency room (ER) visits. Chi-square tests were used to compare HRU rates by age group (<65 and ≥65); t-tests were used to compare means. Results: Of 2,013 CLL patients, median age was 72 years, 78% were ≥65 years of age, 61% were male, 67% Medicare, and 34% were treated in the relapsed setting. The mean comorbidity index was significantly higher in the ≥65 age group compared to the <65 age group (2.2 vs. 1.3, p<0.001). Overall, 97% of patients had an office visit, 31% had a hospitalization, and 34% had an ER visit. There were no statistically significant differences in HRU between age groups, although rates trended higher in the older group: office visits 97% vs. 96%, hospitalizations 32% vs. 29%, and ER visits 34% vs. 32%. Mean hospital length of stay (LOS) was 5.7 days and trended higher in the ≥65 age group (5.8 vs. 5.4 days), but the difference was not statistically significant. Conclusions: Healthcare resource utilization was considerable among patients treated for chronic lymphocytic leukemia. Approximately one-third of patients were hospitalized, and one-third experienced an emergency room visit. Despite a higher mean comorbidity index in the ≥65 age group, HRU was not significantly higher in the older group. Further evaluation of HRU among CLL patients by line of therapy, age, comorbidity index, and payer type is warranted.
Smarter radiation oncology.
Authors: Potters Louis , Kapur Ajay 
Published: February 2017

32 Background: The evolution of radiation oncology (RO) has established granular and detailed CPT codes that define the process of care for patients receiving radiation services. And while each of these codes are legitimately and carefully crafted within the relative value system, they nonetheless serve as surrogates for treatment. As health care moves into a value based future, RO is uniquely situated to offer high-value and affordable cancer care. In addition, ASTRO’s ‘safety is no accident’ and other authoritative articles show a high emphasis of structure, a ‘learning curve’ in process but a dearth of direction on outcomes. A truly integrated practice standard for RO has therefore not yet been realized. Methods: Over the last 5-yrs, based on learning from incidents reported in our department and a risk mitigation study, we have reshaped our practice to be based on three measurable aspects – evidence based and consensus driven care pathways, patient experience and quality. By assimilating the cost perspective into this three-tiered matrix, we believe we have created a model for RO that is predictive of value. We summarize facets of this model that embrace structure, process and outcomes aspects of quality that we believe add most value to the care we provide. Results: The elements of Smarter Radiation Oncology (SRO) were determined to be process mapping, standardization of treatment pathways and toxicity grading, incident reporting, pre-treatment peer review planning contour rounds, our no-fly policy, the Kaizen approach to overhead mitigation, an electronic whiteboard for process co-ordination, survivorship, patient perception of care and the Z-score for measuring operational efficiencies. Conclusions: SRO has shown a sustained and substantial level of improvement in many aspects of the care we provide. And while it is designed to allow for the unencumbered freedom to practice RO, we are often times limited by payers who refuse care based on the artificial and differential aspects of complex therapy. We plan to present how SRO improves value by offering less expensive care that can be used as a foundation for a new episodic payment system based on cost. If adopted, the decision process of therapy becomes agnostic of technology and patient focused.