Potential for Cancer Related Health Services Research Using a Linked Medicare‐Tumor Registry Database

The National Cancer Institute and the Health Care Financing Administration share a strong research interest in cancer costs, access to cancer prevention and treatment services, and cancer patient outcomes. To develop a database for such research, the two agencies have undertaken a collaborative effort to link Medicare Program data with the Surveillance, Epidemiology, and End Results (SEER) Program database. The SEER Program is a system of 9 population-based tumor registries that collect standardized clinical information on cases diagnosed in separate, geographically defined areas covering approximately 10% of the US population. Using a deterministic matching algorithm, the records of 94% of SEER registry cases diagnosed at age 65 or older between 1973 to 1989, or more than 610,000 persons, were successfully linked with Medicare claims files. The resulting database, combining clinical characteristics with information on utilization and costs, will permit the investigation of the contribution of various patient and health care setting factors to treatment patterns, costs, and medical outcomes.

[1]  J. Lave,et al.  The Potential Use of Health Care Financing Administration Data Sets for Health Care Services Research , 1983, Health care financing review.

[2]  R. Prihoda,et al.  The use and costs of Medicare services by cause of death. , 1987, Inquiry : a journal of medical care organization, provision and financing.

[3]  S G Baker,et al.  The impact of breakthrough clinical trials on survival in population based tumor registries. , 1991, Journal of clinical epidemiology.

[4]  J. Samet,et al.  Cancer treatment protocols. Who gets chosen? , 1988, Archives of internal medicine.

[5]  P A Van den Brandt,et al.  Development of a record linkage protocol for use in the Dutch Cancer Registry for Epidemiological Research. , 1990, International journal of epidemiology.

[6]  A Wajda,et al.  The art and science of record linkage: methods that work with few identifiers. , 1986, Computers in biology and medicine.

[7]  B. Bloom,et al.  The epidemiology of disease expenses. The costs of caring for children with cancer. , 1985, JAMA.

[8]  Long Sh,et al.  Medical expenditures of terminal cancer patients during the last year of life. , 1984 .

[9]  A. Gittelsohn,et al.  Variations in medical care among small areas. , 1982, Scientific American.

[10]  A B Nattinger,et al.  Geographic variation in the use of breast-conserving treatment for breast cancer. , 1992, The New England journal of medicine.

[11]  R. Yancik,et al.  Selection factors in clinical trials: results from the Community Clinical Oncology Program Physician's Patient Log. , 1987, Cancer treatment reports.

[12]  E. Fisher,et al.  Studying Outcomes and Hospital Utilization in the Elderly: The Advantages of a Merged Data Base for Medicare and Veterans Affairs Hospitals , 1992, Medical care.

[13]  J. Samet,et al.  Choice of cancer therapy varies with age of patient. , 1986, JAMA.

[14]  A. McMillan,et al.  Nursing home costs for those dually entitled to Medicare and Medicaid , 1987, Health care financing review.

[15]  D. Silverman,et al.  Cancer incidence and mortality trends among whites in the United States, 1947-84. , 1987, Journal of the National Cancer Institute.

[16]  D M Eddy,et al.  The value of mammography screening in women under age 50 years. , 1988, JAMA.

[17]  E P Steinberg,et al.  Accuracy of Medicare Claims Data for Estimation of Cancer Incidence and Resection Rates Among Elderly Americans , 1991, Medical care.

[18]  H. Luft,et al.  Hospital Volume and Patient Outcomes: The Case of Hip Fracture Patients , 1988, Medical care.

[19]  M. Weinstein,et al.  Foundations of cost-effectiveness analysis for health and medical practices. , 1977, The New England journal of medicine.

[20]  K. Levit,et al.  National health expenditures, 1990 , 1991, Health care financing review.

[21]  J. Samet,et al.  Geographic variation in the treatment of localized breast cancer. , 1992, The New England journal of medicine.

[22]  W. Roper,et al.  Effectiveness in Health Care , 1988 .

[23]  J. Young,et al.  Cancer patient survival among ethnic groups in the United States. , 1984, Journal of the National Cancer Institute.

[24]  H S Luft,et al.  Effects of Surgeon Volume and Hospital Volume on Quality of Care in Hospitals , 1987, Medical care.

[25]  M. Brown,et al.  The national economic burden of cancer: an update. , 1990, Journal of the National Cancer Institute.

[26]  E. Burdick,et al.  Use of the Seer Cancer Registry for Technology Assessment , 1991, International Journal of Technology Assessment in Health Care.

[27]  Dental malpractice experience: a closed claim study. , 1993, Medical care.

[28]  J. Wennberg,et al.  Dealing with medical practice variations: a proposal for action. , 1984, Health affairs.

[29]  R H Brook,et al.  Variations in the use of medical and surgical services by the Medicare population. , 1986, The New England journal of medicine.

[30]  D M Eddy,et al.  Variations in physician practice: the role of uncertainty. , 1984, Health affairs.

[31]  E P Steinberg,et al.  Impact of Claims Data Research on Clinical Practice , 1990, International Journal of Technology Assessment in Health Care.

[32]  M. Fahs,et al.  The cost-effectiveness of cervical cancer screening for low-income elderly women. , 1988, JAMA.

[33]  W. McWhorter,et al.  Black/white differences in type of initial breast cancer treatment and implications for survival. , 1987, American journal of public health.

[34]  L. Polissar,et al.  Race, socioeconomic status, and other prognostic factors for survival from colo-rectal cancer. , 1987, Journal of chronic diseases.

[35]  Otis R. Bowen,et al.  What is Quality Care , 1987 .

[36]  R. Temple.  Problems in the Use of Large Data Sets to Assess Effectiveness , 1990, International Journal of Technology Assessment in Health Care.

[37]  F. Pettersson,et al.  Invasive carcinoma of the uterine cervix following diagnosis and treatment of in situ carcinoma. Record linkage study within a National Cancer Registry. , 1989, Radiotherapy and oncology : journal of the European Society for Therapeutic Radiology and Oncology.

[38]  R. M. Shelton,et al.  Hospital use and mortality among Medicare beneficiaries in Boston and New Haven. , 1989, The New England journal of medicine.

[39]  R. Bain,et al.  Racial differences in survival of women with breast cancer. , 1986, Journal of chronic diseases.

[40]  R. Elashoff,et al.  Patterns of care related to age of men with prostate cancer , 1991, Cancer.

[41]  V Mor,et al.  Cost savings in hospice: final results of the National Hospice Study. , 1985, Health services research.

[42]  A Wajda,et al.  Record Linkage Strategies , 1991, Methods of Information in Medicine.

[43]  N. Roos,et al.  Use of claims data systems to evaluate health care outcomes. Mortality and reoperation following prostatectomy. , 1987, JAMA.

[44]  M E Fair,et al.  Application of exact ODDS for partial agreements of names in record linkage. , 1991, Computers and biomedical research, an international journal.

[45]  R. Elashoff,et al.  Patterns of care related to age of breast cancer patients. , 1987, JAMA.

[46]  T. Tong,et al.  Cancer statistics, 1992 , 1992, CA: a cancer journal for clinicians.

[47]  D P Byar,et al.  Problems with using observational databases to compare treatments. , 1991, Statistics in medicine.

[48]  H. Latourette,et al.  Economic status and survival of cancer patients , 1977, Cancer.

[49]  D. Austin,et al.  Progress in the war against cancer. , 1989, New England Journal of Medicine.

[50]  M. McMillen,et al.  Representativeness of the surveillance, epidemiology, and end results program data: recent trends in cancer mortality rates. , 1992, Journal of the National Cancer Institute.

[51]  D P Byar,et al.  Using observational data from registries to compare treatments: the fallacy of omnimetrics. , 1984, Statistics in medicine.

[52]  M. Bergner,et al.  Treatment Modality and Quality Differences for Black and White Breast-Cancer Patients Treated in Community Hospitals , 1989, Medical care.

[53]  E. Fisher,et al.  The accuracy of Medicare's hospital claims data: progress has been made, but problems remain. , 1992, American journal of public health.

[54]  C G Chute,et al.  Social and economic factors in the choice of lung cancer treatment. A population-based study in two rural states. , 1988, The New England journal of medicine.

[55]  N Urban,et al.  Estimating the Treatment Costs of Breast and Lung Cancer , 1991, Medical care.

[56]  M. Stano,et al.  Sources of small area variations in the use of medical care. , 1989, Journal of health economics.

[57]  L. Iezzoni,et al.  Using Administrative Diagnostic Data to Assess the Quality of Hospital Care: Pitfalls and Potential of ICD-9-CM , 1990, International Journal of Technology Assessment in Health Care.

[58]  M. Rothenberg,et al.  Cisplatin-based combination chemotherapy in the treatment of advanced-stage testicular cancer: cost-benefit analysis. , 1990, Journal of the National Cancer Institute.

[59]  R. Doll,et al.  Progress against cancer: an epidemiologic assessment. The 1991 John C. Cassel Memorial Lecture. , 1991, American Journal of Epidemiology.