A novel approach to improve health status measurement in observational claims-based studies of cancer treatment and outcomes Journal Article


Authors: Davidoff, A. J.; Zuckerman, I. H.; Pandya, N.; Hendrick, F.; Ke, X.; Hurria, A.; Lichtman, S. M.; Hussain, A.; P.Weiner, J.; Edelman, M. J.
Article Title: A novel approach to improve health status measurement in observational claims-based studies of cancer treatment and outcomes
Abstract: Objectives: To develop and provide initial validation for a multivariate, claims-based prediction model for disability status (DS), a proxy measure of performance status (PS), among older adults. The model was designed to augment information on health status at the point of cancer diagnosis in studies using insurance claims to examine cancer treatment and outcomes. Materials and Methods: We used data from the 2001-2005 Medicare Current Beneficiary Survey (MCBS), with observations randomly split into estimation and validation subsamples. We developed an algorithm linking self-reported functional status measures to a DS scale, a proxy for the Eastern Cooperative Oncology Group (ECOG) PS scale. The DS measure was dichotomized to focus on good [ECOG 0-2] versus poor [ECOG 3-4] PS. We identified potential claims-based predictors, and estimated multivariate logistic regression models, with poor DS as the dependent measure, using a stepwise approach to select the optimal model. Construct validity was tested by determining whether the predicted DS measure generated by the model was a significant predictor of survival within a validation sample from the MCBS. Results and Conclusion: One-tenth of the beneficiaries met the definition for poor DS. The base model yielded high sensitivity (0.79) and specificity (0.92); positive predictive value. =48.3% and negative predictive value. =97.8%, c-statistic. =0.92 and good model calibration. Adjusted poor claims-based DS was associated with an increased hazard of death (HR. =3.53, 95% CI 3.18, 3.92). The ability to assess DS should improve covariate control and reduce indication bias in observational studies of cancer treatment and outcomes based on insurance claims. © 2013 Elsevier Inc.
Keywords: medicare; health status; observational study; functional status; treatment selection bias
Journal Title: Journal of Geriatric Oncology
Volume: 4
Issue: 2
ISSN: 1879-4068
Publisher: Elsevier Inc.  
Date Published: 2013-04-01
Start Page: 157
End Page: 165
Language: English
PROVIDER: scopus
DOI: 10.1016/j.jgo.2012.12.005
PMCID: PMC3685201
PUBMED: 23795223
DOI/URL:
Notes: --- - "Export Date: 1 May 2013" - ":doi 10.1016/j.jgo.2012.12.005" - "Source: Scopus"
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  1. Stuart Lichtman
    166 Lichtman