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首页> 外文学位 >Geographic and patient variation among Medicare beneficiaries in the use of follow-up testing and skin examinations after local excision of cutaneous melanoma.
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Geographic and patient variation among Medicare beneficiaries in the use of follow-up testing and skin examinations after local excision of cutaneous melanoma.

机译：局部切除皮肤黑色素瘤后，通过随访测试和皮肤检查使用的医疗保险受益人的地理和患者差异。

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摘要

National studies examining the service patterns and epidemiology of melanoma have been primarily based on data from the National Cancer Institute's (NCI) Surveillance, Epidemiology, and End Results (SEER) tumor registry. However, SEER comprises a non-random, 14% geographical sample of the U.S. limiting its ability to examine melanoma in all states and counties. SEER data also does not have treatment beyond 4 months following diagnosis. Medicare claims databases are an alternative source of melanoma patient data and enable the study of this disease throughout the entire U.S. Few studies have employed Medicare data for melanoma research, and no study has validated Medicare claims for the study of melanoma. We use a linked database with both SEER and Medicare claims information for patients diagnosed with melanoma in SEER regions to perform three melanoma studies as described below.; In the first section (chapter 2), we examine the completeness of Medicare claims for the identification of patients with melanoma. Using SEER as the gold standard, we assess the proportion of patients diagnosed in SEER that were also appropriately diagnosed with melanoma in Medicare claims. We found approximately 90% of patients diagnosed with melanoma can be identified for studies using Medicare claims alone.; In the second section (chapter 3), we examine the sensitivity and specificity of Medicare radiation and surgical treatments at least as invasive as excision or biopsy. Here again SEER was considered the gold standard. We found moderately high agreement for radiation therapy (70% sensitivity, and 99% specificity) and fair agreement for surgery codes (70–86% sensitivity and 35–60% specificity).; In the final section (chapter 4), we examine patient, tumor, and geographic variation in the use of follow-up surveillance following diagnosis of invasive melanoma. We found significant variation in surveillance by sex (male greater than female), and geographic area, with up to two-fold differences in surveillance practice. There was also a trend for the older aged to receive less surveillance. As expected, more advanced stage disease was also associated with greater surveillance intensity.
机译：审查黑素瘤服务模式和流行病学的国家研究主要基于美国国家癌症研究所（NCI）的监测，流行病学和最终结果（SEER）肿瘤登记数据。但是，SEER包含美国14％的非随机地理样本，限制了其在所有州和县检查黑素瘤的能力。诊断后超过4个月，SEER数据也没有得到治疗。 Medicare索赔数据库是黑色素瘤患者数据的替代来源，可以在整个美国范围内对该疾病进行研究。很少有研究将Medicare数据用于黑色素瘤研究，并且没有研究能够验证Medicare索赔是否可用于黑色素瘤研究。我们对SEER地区诊断为黑色素瘤的患者使用同时包含SEER和Medicare索赔信息的链接数据库，以进行以下三项黑色素瘤研究。在第一部分（第2章）中，我们检查了用于确定黑素瘤患者的Medicare索赔的完整性。使用SEER作为金标准，我们评估了在Medicare索赔中，在SEER中诊断出也被适当诊断出患有黑色素瘤的患者比例。我们发现仅使用Medicare索赔就可以鉴定出约90％的诊断为黑色素瘤的患者用于研究。在第二部分（第3章）中，我们检查了Medicare放射和外科治疗的敏感性和特异性，至少与切除或活检一样具有侵入性。 SEER在这里再次被视为黄金标准。我们发现放射疗法的敏感性较高（敏感性为70％，特异性为99％），手术规范的敏感性较高（敏感性为70-86％，特异性为35-60％）。在最后一部分（第4章）中，我们检查了浸润性黑色素瘤诊断后使用随访监测的患者，肿瘤和地理差异。我们发现按性别（男性大于女性）和地理区域的监视存在显着差异，监视实践的差异高达两倍。老年人也有受到较少监视的趋势。不出所料，更晚期的疾病也与更高的监测强度有关。

著录项

  • 作者

    Barzilai, David A.;

  • 作者单位

    Case Western Reserve University (Health Sciences).;

  • 授予单位 Case Western Reserve University (Health Sciences).;
  • 学科 Health Sciences Public Health.; Health Sciences Oncology.; Health Sciences Medicine and Surgery.; Health Sciences Health Care Management.
  • 学位 Ph.D.
  • 年度 2003
  • 页码 114 p.
  • 总页数 114
  • 原文格式 PDF
  • 正文语种 eng
  • 中图分类 预防医学、卫生学;肿瘤学;预防医学、卫生学;
  • 关键词

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