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Certain cancer case ascertainment methods used in Quebec and elsewhere are known to underestimate the burden of cancer, particularly for some subgroups. Algorithms using claims data are a low-cost option to improve the quality of cancer surveillance, but have not frequently been implemented at the population-level. Our objectives were to 1) develop a colorectal cancer (CRC) case ascertainment algorithm using population-level hospitalization and physician billing data, 2) validate the algorithm, and 3) describe the characteristics of cases.
We linked physician billing, hospitalization, and tumor registry data for 2,013,430 Montreal residents age 20+ (2000-2010). We compared the performance of three algorithms based on diagnosis and treatment codes from different data sources. We described identified cases according to age, sex, socioeconomic status, treatment patterns, site distribution, and time trends. All statistical tests were two-sided.
Our algorithm based on diagnosis and treatment codes identified 11,476 of the 12,933 incident CRC cases contained in the tumor registry as well as 2317 newly-captured cases. Our cases share similar overall time trends and site distributions to existing data, which increases our confidence in the algorithm. Our algorithm captured proportionally 35% more individuals age 50 and younger among CRC cases: 8.2% vs. 5.3%. The newly captured cases were also more likely to be living in socioeconomically advantaged areas.
Our algorithm provides a more complete picture of population-wide CRC incidence than existing case ascertainment methods. It could be used to estimate long-term incidence trends, aid in timely surveillance, and to inform interventions, in both Quebec and other jurisdictions.
Electronic supplementary material
The online version of this article (10.1186/s12874-018-0494-x) contains supplementary material, which is available to authorized users.
Colorectal cancer, Algorithm, Incidence, Administrative health data, Cancer registry
Measuring colorectal cancer incidence: the performance of an algorithm using administrative health data
Mamadou Diop,1,2,3,4 Erin C. Strumpf,3,4 and Geetanjali D. Dattacorresponding author1,2
To examine the factors explaining primary care physicians’ (PCPs) decision to leave patient‐centered medical homes (PCMHs).
Five‐year longitudinal data on all the 906 PCPs who joined a PCMH in the Canadian province of Quebec, known there as a Family Medicine Group.
We use fixed‐effects and random‐effects logit models, with a variety of regression specifications and various subsamples. In addition to these models, we examine the robustness of our results using survival analysis, one lag in the regressions and focusing on a matched sample of quitters and stayers.
Data Collection/Extraction Methods
We extract information from Quebec’s universal health insurer billing data on all the PCPs who joined a PCMH between 2003 and 2005, supplemented by information on their elderly and chronically ill patients.
About 17 percent of PCPs leave PCMHs within 5 years of follow‐up. Physicians’ demographics have little influence. However, those with more complex patients and higher revenues are less likely to leave the medical homes. These findings are robust across a variety of specifications.
As expected, higher revenue favors retention. Importantly, our results suggest that PCMH may provide appropriate support to physicians dealing with complex patients.
Canada, health care workforce, patient‐centered medical homes, physician retention, primary care
Explaining primary care physicians’ decision to quit patient‐centered medical homes: Evidence from Quebec, Canada
Mehdi Ammi, PhD,corresponding author 1 Mamadou Diop, MSc, 2 and Erin Strumpf, PhD 3 , 4
Tuberculous destroyed lung (TDL) contributes to patient mortality via acute exacerbation and combined medical comorbidities. This study characterized the clinical characteristics and economic burden of patients with TDL using large scale database, Health Insurance Review and Assessment Service (HIRA) data.
We searched the HIRA national database to identify patients diagnosed with TDL from January 01, 2011 to December 31, 2015. The clinical characteristics of the patients were collected and the 5-year claims data were analyzed.
In total, 645,031 patients (55% male, mean age, 59.6 years) were enrolled over the 5 years. During the study period, 98.5% of the patients visited a primary care clinic and 71.1% and 93.2% visited secondary and tertiary hospitals, respectively. Patients spent a median of 5 days for inpatient services, and were admitted to the hospital a median of 0.62±1.2 times per person annually. Annual total cost per person was $1,838 and half of the total cost was expended for inpatient services. About 68.9% of the patients were prescribed respiratory medications, and $12 million was paid. Oral bronchodilators (46.5%) and methylxanthine (35.2%) were used more frequently than inhaled corticosteroids (ICSs)/long-acting β2 agonist (LABA) combination agents (11.6%) or inhaled long-acting muscarinic antagonists (LAMAs) (7.5%).
TDL imposes a high medical economic burden in Korea. The estimated economic costs were mainly made up of inpatient services and outpatient medication prescriptions. Interventions to prevent acute disease exacerbations and progression of comorbid conditions should be accompanied to alleviate the clinical and economic burden of TDL.
Tuberculosis, chronic obstructive lung disease, economic burden
Clinical characteristics and economic burden of tuberculous-destroyed lung in Korea: a National Health Insurance Service-National Sample Cohort-based study
Hwa Young Lee,1,# Deok Jae Han,1,# Kyung Joo Kim,1 Tae Hoon Kim,2 Yeon-Mok Oh,3 and Chin Kook Rheecorresponding author1