Data Sources for Measuring Colorectal Endoscopy Use Among Medicare Enrollees

• Published in: Cancer epidemiology, biomarkers & prevention biomarkers & prevention, 2007-10, Vol.16 (10), p.2118-2127
• Main Authors: SCHENCK, Anna P, KLABUNDE, Carrie N, WARREN, Joan L, PEACOCK, Sharon, DAVIS, William W, HAWLEY, Sarah T, PIGNONE, Michael, RANSOHOFF, David F
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; claims; colonoscopy; Colonoscopy - utilization; colorectal neoplasms; Colorectal Neoplasms - diagnosis; Colorectal Neoplasms - epidemiology; Data Collection - statistics & numerical data; Female; Health Surveys; Humans; Insurance Claim Review - statistics & numerical data; Male; Mass Screening - utilization; medical record audit; Medical sciences; Medicare; Medicare - statistics & numerical data; Middle Aged; North Carolina; Reproducibility of Results; self disclosure; sigmoidoscopy; Sigmoidoscopy - utilization; South Carolina; Tumors; United States; Utilization Review - statistics & numerical data
• ISSN: 1055-9965; 1538-7755
• DOI: 10.1158/1055-9965.EPI-07-0123

Background: Estimates of colorectal cancer test use vary widely by data source. Medicare claims offer one source for monitoring test use, but their utility has not been validated. We compared ascertainment of sigmoidoscopy and colonoscopy between three data sources: self reports, Medicare claims, and medical records. Materials and Methods: The study population included Medicare enrollees residing in North Carolina ( n = 561) who had participated in a telephone survey on colorectal cancer tests. Medicare claims were obtained for the 5 years preceding the survey (January 1, 1998 to December 31, 2002). Information about sigmoidoscopy and colonoscopy procedures conducted in physician offices were abstracted from medical records. Sensitivity, specificity, positive predictive value, negative predictive value, agreement, and κ statistics were calculated using the medical record as the gold standard. Agreement on specific procedure type and purpose was also assessed. Results: Agreement between claim and medical record regarding whether an endoscopic procedure had been done was high (over 90%). Agreement between self report and medical record and between self report and claim was good (79% and 74%, respectively). All three data sources adequately distinguished the type of procedure done. None of the data sources showed reliable levels of agreement regarding procedure purpose (screening or diagnostic). Conclusion: Medicare claims can provide accurate information on whether a patient has undergone colorectal endoscopy and may be more complete than physician medical records. Medicare claims cannot be used to distinguish screening from diagnostic tests. Recognizing this limitation, researchers who use Medicare claims to assess rates of colorectal testing should include both screening and diagnostic endoscopy procedures in their analyses. (Cancer Epidemiol Biomarkers Prev 2007;16(10):2118–27)