State-wide application of breast and colon cancer quality measures (QMs) using linked claims and registry data.

Abstract

6004 Background: The National Quality Forum (NQF) endorsed QMs for breast and colorectal (CR) cancer in 2007. Application by cancer registries may yield inaccurately low measures of QM concordance because of incomplete data on systemic therapy and radiation. Linkage of registry data to insurance claims may provide a more robust measure of quality at the community level. This study examined concordance with NQF QMs using payer claims linked to the National Cancer Data Base and the Ohio Cancer Incidence Surveillance System (combined data = REG). Methods: Claims from United Healthcare and Anthem Blue Cross Blue Shield of Ohio were linked to REG for patients treated in Ohio during 2004-06 for breast and CR cancer. Cases with fewer than 270 days of claims were excluded. Concordance with NQF QM's was assessed by examining radiation, chemotherapy, and endocrine therapy defined from REG and claims as treatment actually administered. Results: The claims-registry linkage identified 2,447 women with stage 0–III breast cancer and 668 patients with stage 0–III CR cancer. The Table shows concordance with NQF QMs. Conclusions: Linkage of claims to registries allows more accurate community-wide assessment of quality of cancer care. Concordance with NQF QMs among insured patients in Ohio was very high. Efforts to expand claims-registry linkages are warranted for quality assessment. NQF measure N cases Concordance with NQF QMs by data source Registry only Claims only Claims + registry Stage I-III breast cancer; breast-conserving surgery; age < 70; radiation < 365 days of diagnosis (Dx) 932 84% 95% 96% T1cN0M0 and stage II-III breast cancer; hormone receptor negative; age < 70; chemotherapy < 120 days of Dx 267 77% 92% 94% T1cN0M0 and stage II-III breast cancer; hormone receptor positive; endocrine therapy < 365 days of Dx 613 61% 84% 92% Stage III colon cancer; age < 80 chemotherapy < 120 days of Dx 161 82% 91% 96% Author Disclosure Employment or Leadership Position Consultant or Advisory Role Stock Ownership Honoraria Research Funding Expert Testimony Other Remuneration UnitedHealthCare