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Grant Details

Grant Number: 5R01CA072076-09 Interpret this number
Primary Investigator: Freeman, Jean
Organization: University Of Texas Medical Br Galveston
Project Title: Evaluating Mammography Claims Data
Fiscal Year: 2006
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Abstract

DESCRIPTION (provided by applicant): Variations in the use of breast cancer screening, diagnostic and treatment services have long raised questions about the quality of breast cancer care and its impact on patient outcomes. Wide variations in mammographic interpretation and high rates of breast biopsies have raised particular concerns about the quality of screening mammography and how quality varies by different mammography providers and different population groups. In response to these concerns, the Institute of Medicine (IOM) has recommended that the use of screening mammography in community practice be carefully examined and that ways of monitoring performance should be developed. The IOM further recommends exploring the use of the Medicare claims database to describe trends in the use of screening mammography, examine geographic variations in screening incidence and study the outcomes of routine screening. Our research has shown that the Medicare data can be a valid source of information on screening, provided appropriate methods are used to define screening practices using information on the claims. We now propose to apply these methods in a population-based study of screening quality. The study will use SEER and Medicare claims data to examine screening performance measures among the SEER areas over the period 1998-1999. Our objectives are to: 1) investigate the relationship between screening performance (sensitivity and specificity of screening mammography) and the characteristics of radiologists and patients and 2) evaluate whether Medicare claims alone can provide valid measures of sensitivity and specificity compared to a linked SEER-Medicare database. The wide dissemination of screening mammography into community practice, particularly among older women, necessitates the ongoing assessment of its performance. Through this population-based study we will be able to compare screening performance by characteristics of patients and radiologists. Moreover, if we demonstrate that Medicare data alone provide valid measures of sensitivity and specificity, then our approach will allow for the generation of screening quality indicators (specificity) for virtually 100% of U.S. radiologists.

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Publications

Reducing the effects of lead-time bias, length bias and over-detection in evaluating screening mammography: a censored bivariate data approach.
Authors: Mahnken JD, Chan W, Freeman DH Jr, Freeman JL
Source: Stat Methods Med Res, 2008 Dec;17(6), p. 643-63.
EPub date: 2008 Apr 29.
PMID: 18445697
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Comorbid disease and cancer: the need for more relevant conceptual models in health services research.
Authors: Geraci JM, Escalante CP, Freeman JL, Goodwin JS
Source: J Clin Oncol, 2005 Oct 20;23(30), p. 7399-404.
PMID: 16234509
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Using Medicare data to estimate the prevalence of breast cancer screening in older women: comparison of different methods to identify screening mammograms.
Authors: Randolph WM, Mahnken JD, Goodwin JS, Freeman JL
Source: Health Serv Res, 2002 Dec;37(6), p. 1643-57.
PMID: 12546290
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Regular mammography use is associated with elimination of age-related disparities in size and stage of breast cancer at diagnosis.
Authors: Randolph WM, Goodwin JS, Mahnken JD, Freeman JL
Source: Ann Intern Med, 2002 Nov 19;137(10), p. 783-90.
PMID: 12435214
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Studying radiation therapy using SEER-Medicare-linked data.
Authors: Virnig BA, Warren JL, Cooper GS, Klabunde CN, Schussler N, Freeman J
Source: Med Care, 2002 Aug;40(8 Suppl), p. IV-49-54.
PMID: 12187168
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Measuring breast, colorectal, and prostate cancer screening with medicare claims data.
Authors: Freeman JL, Klabunde CN, Schussler N, Warren JL, Virnig BA, Cooper GS
Source: Med Care, 2002 Aug;40(8 Suppl), p. IV-36-42.
PMID: 12187166
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A non-parametric method for the comparison of partial areas under ROC curves and its application to large health care data sets.
Authors: Zhang DD, Zhou XH, Freeman DH Jr, Freeman JL
Source: Stat Med, 2002 Mar 15;21(5), p. 701-15.
PMID: 11870811
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Accuracy and completeness of Medicare claims data for surgical treatment of breast cancer.
Authors: Du X, Freeman JL, Warren JL, Nattinger AB, Zhang D, Goodwin JS
Source: Med Care, 2000 Jul;38(7), p. 719-27.
PMID: 10901355
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Information on radiation treatment in patients with breast cancer: the advantages of the linked medicare and SEER data. Surveillance, Epidemiology and End Results.
Authors: Du X, Freeman JL, Goodwin JS
Source: J Clin Epidemiol, 1999 May;52(5), p. 463-70.
PMID: 10360342
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The declining use of axillary dissection in patients with early stage breast cancer.
Authors: Du X, Freeman JL, Goodwin JS
Source: Breast Cancer Res Treat, 1999 Jan;53(2), p. 137-44.
PMID: 10326790
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