Developing a cancer‐specific trigger tool to identify treatment‐related adverse events using administrative data

• Published in: Cancer medicine (Malden, MA) MA), 2020-02, Vol.9 (4), p.1462-1472
• Main Authors: Weingart, Saul N., Nelson, Jason, Koethe, Benjamin, Yaghi, Omar, Dunning, Stephan, Feldman, Albert, Kent, David M., Lipitz‐Snyderman, Allison
• Format: Article
• Language: English
• Subjects: Administrative Claims, Healthcare - statistics & numerical data; adverse event; Aged; Algorithms; Ambulatory care; Antineoplastic Agents - adverse effects; Bicarbonates; Blood transfusion; Breast; Breast cancer; Cancer therapies; Chemotherapy; Clinical Cancer Research; Codes; Colorectal cancer; Comorbidity; Computed tomography; Drug-Related Side Effects and Adverse Reactions - blood; Drug-Related Side Effects and Adverse Reactions - diagnosis; Drug-Related Side Effects and Adverse Reactions - epidemiology; Drug-Related Side Effects and Adverse Reactions - etiology; Educational attainment; epidemiology; Ethnicity; Family income; Female; Fever; Follow-Up Studies; Humans; Hypoxemia; Laboratories; Lung cancer; Male; Medical diagnosis; Medical errors; Medical Oncology - methods; Medicare; Metastases; Metastasis; Middle Aged; Neoplasms - blood; Neoplasms - therapy; Nephrology; Neutropenia; Oncology; Original Research; Patient Safety; Potassium; Prostate; Prostate cancer; Quality; Quality of care; Radiation Injuries - blood; Radiation Injuries - diagnosis; Radiation Injuries - epidemiology; Radiation Injuries - etiology; Radiation therapy; Retrospective Studies; Risk Assessment - methods; Risk Factors; Studies; Surgery; Surgical outcomes; trigger tool
• ISSN: 2045-7634; 2045-7634
• DOI: 10.1002/cam4.2812

Background As there are few validated tools to identify treatment‐related adverse events across cancer care settings, we sought to develop oncology‐specific “triggers” to flag potential adverse events among cancer patients using claims data. Methods 322 887 adult patients undergoing an initial course of cancer‐directed therapy for breast, colorectal, lung, or prostate cancer from 2008 to 2014 were drawn from a large commercial claims database. We defined 16 oncology‐specific triggers using diagnosis and procedure codes. To distinguish treatment‐related complications from comorbidities, we required a logical and temporal relationship between a treatment and the associated trigger. We tabulated the prevalence of triggers by cancer type and metastatic status during 1‐year of follow‐up, and examined cancer trigger risk factors. Results Cancer‐specific trigger events affected 19% of patients over the initial treatment year. The trigger burden varied by disease and metastatic status, from 6% of patients with nonmetastatic prostate cancer to 41% and 50% of those with metastatic colorectal and lung cancers, respectively. The most prevalent triggers were abnormal serum bicarbonate, blood transfusion, non‐contrast chest CT scan following radiation therapy, and hypoxemia. Among patients with metastatic disease, 10% had one trigger event and 29% had two or more. Triggers were more common among older patients, women, non‐whites, patients with low family incomes, and those without a college education. Conclusions Oncology‐specific triggers offer a promising method for identifying potential patient safety events among patients across cancer care settings. A claims‐based trigger tool was developed to identify potential adverse events and medical errors among 320 000 patients with breast, colorectal, lung, and prostate cancers. During an initial year of therapy, cancer‐specific trigger events affected 19% of patients and varied by disease and metastatic status, from 6% of patients with nonmetastatic prostate cancer to 41% and 50% of those with metastatic colorectal and lung cancers, respectively.