Profiling Providers on Use of Adjuvant Chemotherapy by Combining Cancer Registry and Medical Record Data

PURPOSE: Treatment information collected by cancer registries can be used to monitor the provision of guideline-recommended chemotherapy to colorectal cancer patients. Incomplete information may bias comparisons of these rates. We developed statistical methods that combine data from a registry and physicians' records to assess hospital quality. DATA: From California Cancer Registry data, we selected all patients (n=12,594) newly diagnosed with stage III colon cancer or stage II or III rectal cancer from 428 hospitals during the years 1994 to 1998. To assess rates and predictors of underreporting of chemotherapy, we surveyed physicians treating 1449 of these patients from 98 hospitals during the years 1996 to 1997. METHODS: Using Bayesian statistical models, we imputed unobserved treatments. We studied the impact of underreporting on provider profiling by comparing rankings, estimates, and credible intervals based only on registry data to those incorporating physician survey data. RESULTS: Analyses that account for incompleteness of reporting yielded wider credible intervals for provider profiles than those that ignored such incompleteness. Among the 109 (25%) hospitals in the highest quartile of chemotherapy rates according to the registry data, 16 were not so classified when incomplete reporting was taken into account. With the more comprehensive model, 12 hospitals could be identified that ranked in the top quartile with probability>0.90. CONCLUSION: Estimates of adjusted hospital chemotherapy rates based solely on cancer registry data overstate the precision of assessments of hospital quality. Using additional information from a physician survey and applying rigorous statistical models, better inferences can be drawn about provider quality

Cancer · Cancer registry · Colorectal cancer · Confidence interval · Guideline · Medical record · Quartile · Colorectal Cancer Surgical Treatments · Emergency Medicine · Global Cancer Incidence and Screening · Internal Medicine · Medicine · Patient Satisfaction in Healthcare

• Test validity in morphosyntactic measures for typical and SLI incipient Spanish–English bilinguals

  Open Access•Irene Checa García, Irene Checa-García et al.•Language Testing•2019

  Incluir item

• Diabetes Health Disparities

  Open Access•Monica E Peek, Algernon Cargill et al.•Medical Care Research and Review•2007

  Incluir item

• Data Matching to Allocate Doctors to Patients in a Microsimulation Model of the Primary Care Process in New Zealand

  Open Access•Martin von Randow, Peter Davis et al.•Social Science Computer Review•2011

  Incluir item

• Using Knowledge of Multiple Levels of Variation in Care to Target Performance Incentives to Providers

  Marc Turenne, Marc N Turenne et al.•Medical Care•2008

  Incluir item

• Understanding the Challenges of Adjuvant Treatment Measurement and Reporting in Breast Cancer

  Nina A Bickell, Ann Scheck Mcalearney et al.•Medical Care•2013

  Incluir item

• Risk-Adjusting Hospital Inpatient Mortality Using Automated Inpatient, Outpatient, and Laboratory Databases

  Gabriel J Escobar, J Greene et al.•Medical Care•2008

  Incluir item

• Analysis of Incomplete Multivariate Data

  Joseph L Schafer•Analysis of Incomplete…•1997

  Incluir item

• A Theory for Record Linkage

  Ivan P Fellegi, Alan B Sunter•Journal of the American…•1969

  Incluir item

• Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases

  Open Access•Richard A Deyo, R DEYO•Journal of Clinical Epidemiology•1992

  Incluir item

• Inference and missing data

  Donald B Rubin•Biometrika•1976

  Incluir item

• Completeness of Information on Adjuvant Therapies for Colorectal Cancer in Population-Based Cancer Registries

  Rosemary D Cress, Alan M Zaslavsky et al.•Medical Care•2003

  Incluir item

• Variations in Standardized Hospital Mortality Rates for Six Common Medical Diagnoses

  Gary E Rosenthal, Amrik Shah et al.•Medical Care•1998

  Incluir item

• The Outcomes of Cancer Outcomes Research

  Joseph Lipscomb, Claire Snyder et al.•Medical Care•2002

  Incluir item

• Geographic Variation of Procedure Utilization

  Constantine Gatsonis, Sharon‐Lise T Normand et al.•Medical Care•1993

  Incluir item