What are the SEER - Medicare data

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What are the SEER - Medicare data Powered By Docstoc
					        Using SEER-Medicare Data to
Enhance Registry Data to Assess Quality of Care




                       Joan Warren
                Applied Research Program
                 National Cancer Institute

 NAACCR
 June 6, 2007
     What are the SEER - Medicare data?
   The SEER-Medicare data are the result of the linkage
    of two large population-based sources of data:
    cancer registry data from NCI’s sponsored cancer
    registries (SEER program) and Medicare claims from
    CMS

   The SEER registries collect detailed clinical,
    demographic and cause of death information for
    persons with cancer

   Medicare data are longitudinal, with claims for all
    covered fee-for-service health care from the time of
    eligibility to death

   There are currently over 1.8 million cases in the data
       Why link the SEER-Medicare Data?
The linked data can be used for a number of analyses that span the
                 course of cancer control activities

Diagnosis/ Tx          Survivorship        Second Occurrence  Terminal Care

Patterns of care        Late effects of      Rates of second           Use of hospice
                        treatment            primaries                 services
Peri-operative
complications
                        Post-diagnostic      Relationship of
Volume outcomes         surveillance         second events to
                                             initial treatment and     Patterns of care
studies
                                             ongoing                   during the last
                                             surveillance              year of life
Extent of staging       Treatment of
                        prevalent cancers
Comorbidities

                        Survival

                 Quality of care, health disparities, and cost of treatment
               Persons included in the
                SEER-Medicare Data

   100% of patients in the SEER data who are found to be
    Medicare eligible

   5% random sample of persons residing in the SEER
    areas who have not been diagnosed with cancer
      These people can be used to create comparison
       groups as well as to create estimates of diagnostic
       testing and treatment practices in the entire population
      Medicare files available for the non-cancer cases are
       the same as for the cancer cases
           What is included in the
           SEER-Medicare Data
   SEER Data including
     Incidence, site, stage, initial tx, demographics
      and vital status

   Medicare claims for:
     Short stay hospitals

     Physician and lab services

     Hospital outpatient claims

     Home health and hospice bills
         Other variables available in the
             SEER-Medicare data


   1990 and 2000 Census data at the census tract
    and zip code level for ecological SES measures

   Health Care Service Area from Area Resource
    File

   Hospital and physician characteristics- ex.
    bedsize, hospital ownership, physician specialty
    Years of SEER-Medicare Data Available

   SEER data are available for the entire time a registry
    has participated in the SEER program; some registries
    go back to 1973

   Medicare claims are available from 1991-2005, except
    for hospital data that are available back to 1986

   Cases reported through 2002

   Update of the linkage is underway. It will include cases
    through 2005 with Medicare claims through 2006.
          Limitations of the SEER-Medicare Data
   Observational data- pts are not randomly assigned to
    treatment

   Non-covered services excluded: prescription drugs, long-
    term care, free screenings

   Reasons for tests are not known; this raises challenges
    w/measuring screening

   Results of tests not available

   Does not include claims for care provided to persons in
    HMOs (about 22% in SEER areas)

   Under 65 population includes only the disabled/ESRD
     Using the SEER-Medicare Data to Assess
              Quality of Cancer Care

   The SEER-Medicare data are a good resource to
    measure quality of cancer care:
      Data are longitudinal
      Can look at claims prior to diagnosis to adjust for pre-
       existing conditions
      Cross most components of the health care system


   Challenges of using these data to assess quality of care
      Secondary data do not capture factors that may
       influence treatment choices; especially an issue in the
       elderly
      There are a limited number of treatments for which
       there is consensus regarding treatment
     Examples of Quality of Care Studies
        Using SEER-Medicare Data

Investigators have used SEER-Medicare data to:
 Assess if patients received routinely provided care-

    Surgery

    Adjuvant therapy (RT/Chemo)

    Post-diagnostic surveillance



   Examine health system factors related to outcomes
      Hospital and physician characteristics

      Volume outcomes
     Are All Medicare Beneficiaries with Early-Stage
         Non-Small Cell Lung Cancer Receiving
              Potentially Curative Surgery?

   Black persons with early stage non-small cell lung
    cancer have poorer survival than do comparable
    white persons

   Early-stage non-small cell lung cancer is
    potentially curable by surgical resection

   Investigators used SEER-Medicare data to
    estimate the rates of surgical treatment between
    blacks and whites and to determine if disparities
    in survival could be explained by differences in
    use of surgery
                       Survival of Medicare beneficiaries aged 65+ with Stage I/II
                           non-small cell lung cancer, by treatment and race,
                                               1985-1993
                         1
                       0.9
                       0.8
PROPORTION SURVIVING




                       0.7                                               Resection,
                       0.6                                               White
                                                                         Resection,
                       0.5                                               Black
                       0.4                                               No Resection,
                                                                         White
                       0.3                                               No Resection,
                       0.2                                               Black
                       0.1
                         0
                             0    2        4       6         8     10
                                      YEARS FROM DIAGNOSIS
              CONCLUSIONS

The lower survival rate among black patients
with early-stage, non-small-cell lung cancer, as
compared with white patients, is largely
explained by the lower rate of surgical treatment
among blacks.
    Use of Adjuvant Chemotherapy for Medicare
     Beneficiaries with Stage III Colon Cancer

   Use of adjuvant chemotherapy following a diagnosis of
    Stage III colon cancer has been guideline treatment for
    many years

   There are concerns that some patients are not receiving
    adjuvant treatment because of their age or race

   Investigators have used the SEER-Medicare data to
    assess use of adjuvant chemo in Medicare beneficiaries
    with Stage III colon cancer
          Receipt of Adjuvant Chemotherapy for Medicare
       Beneficiaries with Stage III Colon Cancer by Age Group

                      Percent of Patients Receiving Adjuvant Therapy
             100%

              80%

              60%

              40%

              20%

               0%
                      65-69      70-74        75-79         80-84      85-89
                                         Age at Diagnosis
Schrag et al, JNCI 2001
    Referral to Medical Oncologist and Receipt of
 Chemotherapy Among Those Who Saw an Oncologist
Among Medicare Beneficiaries with Stage III Colon Cancer
         Percent
          100

            80

            60
                                                     Black
            40
                                                     White
            20

             0
                      Saw a Medical   Received
                      Oncologist      Chemotherapy

Baldwin LM, et al. JNCI Aug 2005.
      Assessment of Post-diagnostic Surveillance

SEER-Medicare data have been used to evaluate whether
patients are receiving the recommended surveillance
following a cancer diagnosis:

   Persons with superficial bladder cancer who have not
    undergone total cystectomy should undergo bladder
    surveillance with cystoscopy every 3-6 months

   Men with prostate cancer who opt for expectant
    management should have a PSA test every 6 months
                             Surveillance among Medicare Eligible Patients with
                             Superficial Bladder Cancer over a 30-month interval
                                      following diagnosis, by Age Group

                             100
                             90
      % Receiving Followup




                             80
                             70
                             60
                             50
                             40                                                65-69
                             30                                                70-74
                             20
                                                                               75-79
                                                                               80-84
                             10                                                85+
                              0
                                   1+      2+           3+            4+   5
                                                Number of Followups



Source: Schrag D et al. J Natl Cancer Inst. 2003 Apr 16.
      Receipt of PSA Testing 7-24 Months Following a
             Diagnosis of Prostate Cancer for
          Men Choosing Expectant Management
                70

                60

                50

                                                        0 tests
                40
      Percent




                                                        1-4 tests
                                                        5-8 tests
                30
                                                        >9 tests

                20

                10

                 0
                      African-       Hispanic   White
                     American

Shavers, et al., Medical Care 2004
                     Conclusions

   Bladder surveillance: Only 40% of the cohort
    received the recommended surveillance

   PSA tests: African Americans and Hispanics
    were significantly less likely to receive a PSA
    test. Black men are more likely to be treated
    with expectant management.
    Does Provider Specialty or Provider Volume
          Impact on Patient Outcomes?
   Earlier studies have suggested that provider
    specialty and/or volume may improve patient
    outcomes

   Investigators used the SEER-Medicare data to
    compare outcomes for women following surgery for
    ovarian cancer

   Two studies were done:
      Does the specialty of the physician performing
       the surgeon impact on overall survival ?
      Is there a volume-outcome effect?
     Adjusted Cox proportional hazards model
           for death from any cause for
       Medicare women with ovarian cancer
                                  Adjusted Hazards
                                        Ratio

    General Surgeon                    1.00

    Gynecologic oncologist             0.85*

    General gynecologist               0.86*




Earle CC et al. JNCI Feb 1 2006                * P < 0.05
  Percent of Patients with Stage III/IV Ovarian Cancer
          Surviving 48 Months After Surgery
           by Hospital and Surgeon Volume


     35
     30
     25
                                                          Low
     20
                                                          Medium
     15                                                   High
     10
      5
      0
              Hospital Volume            Surgeon Volume


Schrag D. et al. J Natl Cancer Inst. 2006 Feb 1.
              Conclusions About
           Ovarian Cancer Treatment

   These data show that the volume of procedures
    is not a significant factor in patient survival

   It appears that physician training is associated
    with improved outcomes
       Final Thoughts About Using
SEER-Medicare Data to Assess Quality of Care

   Secondary data sources such as SEER-Medicare
    can be a powerful source of information because of
    their size and breadth

   However, these types of data do not offer definitive
    information about quality- why was treatment not
    given, what other factors influenced outcomes

   These data should be used to determine where
    more in-depth research should be focused.
More Details on the SEER-Medicare data


           SEER-Medicare WEB site
http://appliedresearch.cancer.gov/seermedicare

				
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