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Treatment Patterns for Prostate Cancer: Comparison of Medicare Claims Data to Medical Record Review

Fleming, Steven T. PhD*; Hamilton, Ann S. PhD; Sabatino, Susan A. MD, MPH; Kimmick, Gretchen G. MD, MS§; Wu, Xiao-Cheng MD, MPH; Owen, Jean B. PhD; Huang, Bin DrPH, MS#; Hwang, Wenke PhD**for the Patterns of Care Study Group

doi: 10.1097/MLR.0b013e318277eba5
Applied Methods

Background: As evidence-based guidelines increasingly define standards of care, the accurate reporting of patterns of treatment becomes critical to determine if appropriate care has been provided. We explore the level of agreement between claims and record abstraction for treatment regimens for prostate cancer.

Methods: Medicare claims data were linked to medical records abstraction using data from the Centers for Disease Control and Prevention’s National Program of Cancer Registry–funded Breast and Prostate Patterns of Care study. The first course of therapy included surgery, radiation therapy (RT), and hormonal therapy with luteinizing hormone–releasing hormone agonists.

Results: The linked sample included 2765 men most (84.7%) of whom had stage II prostate cancer. Agreement was excellent for surgery (κ=0.92) and RT (κ=0.92) and lower for hormonal therapy (κ=0.71); however, most of the discrepancies were due to greater number of patients reported who received hormonal therapy in the claims database than in the medical records database. For some standard multicomponent management strategies sensitivities were high, for example, hormonal therapy with either combination RT (86.9%) or cryosurgery (96.6%).

Conclusions: Medicare claims are sensitive for determining patterns of multicomponent care for prostate cancer and for detecting use of hormonal therapy when not reported in the medical records abstracts.

*Department of Epidemiology, University of Kentucky College of Public Health, Lexington, KY

Keck School of Medicine of University of Southern California, Los Angeles, CA

Centers for Disease Control and Prevention, Atlanta, GA

§Duke University Medical Center, Durham, NC

Louisiana State University Health Sciences Center, New Orleans, LA

American College of Radiology Clinical Research Center, Philadelphia, PA

#University of Kentucky Markey Cancer Center, Lexington, KY

**Pennsylvania State University College of Medicine, Hershey, PA

The Breast and Prostate Cancer Data Quality and Patterns of Care Study was supported by the Centers for Disease Control and Prevention through cooperative agreements with the California Cancer Registry (Public Health Institute) (1-U01-DP000260), Emory University (1-U01-DP000258), Louisiana State University Health Sciences Center (1-U01-DP000253), Minnesota Cancer Surveillance System (Minnesota Department of Health) (1-U01-DP000259), Medical College of Wisconsin (1-U01-DP000261), University of Kentucky (1-U01-DP000251), and Wake Forest University (1-U01-DP000264). The findings and conclusions in this report are those of the authors and do not necessarily represent the official position of the Centers for Disease Control and Prevention.

The authors declare no conflict of interest.

Reprints: Steven T. Fleming, PhD, Department of Epidemiology, University of Kentucky College of Public Health, 121 Washington Avenue, Lexington, KY 40536. E-mail:

© 2014 by Lippincott Williams & Wilkins.