Grant Number:	2R01CA072076-07A1 Interpret this number
Primary Investigator:	Freeman, Jean
Organization:	University Of Texas Medical Br Galveston
Project Title:	Evaluating Mammography Claims Data
Fiscal Year:	2004

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.




Reducing the effects of lead-time bias, length bias and over-detection in evaluating screening mammography: a censored bivariate data approach.
Authors: Mahnken J.D. , Chan W. , Freeman D.H. , Freeman J.L. .
Source: Statistical Methods In Medical Research, 2008 Dec; 17(6), p. 643-63.
PMID: 18445697
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Evaluating health care performance: strengths and limitations of multilevel analysis.
Authors: Tan A. , Freeman J.L. , Freeman D.H. .
Source: Biometrical Journal. Biometrische Zeitschrift, 2007 Aug; 49(5), p. 707-18.
PMID: 17638296
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Variation in false-positive rates of mammography reading among 1067 radiologists: a population-based assessment.
Authors: Tan A. , Freeman D.H. , Goodwin J.S. , Freeman J.L. .
Source: Breast Cancer Research And Treatment, 2006 Dec; 100(3), p. 309-18.
PMID: 16819566
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Comorbid disease and cancer: the need for more relevant conceptual models in health services research.
Authors: Geraci J.M. , Escalante C.P. , Freeman J.L. , Goodwin J.S. .
Source: Journal Of Clinical Oncology : Official Journal Of The American Society Of Clinical Oncology, 2005-10-20 00:00:00.0; 23(30), p. 7399-404.
PMID: 16234509
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Measuring the performance of screening mammography in community practice with Medicare claims data.
Authors: Freeman J.L. , Goodwin J.S. , Zhang D. , Nattinger A.B. , Freeman D.H. .
Source: Women & Health, 2003; 37(2), p. 1-15.
PMID: 12733550
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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 W.M. , Mahnken J.D. , Goodwin J.S. , Freeman J.L. .
Source: Health Services Research, 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 W.M. , Goodwin J.S. , Mahnken J.D. , Freeman J.L. .
Source: Annals Of Internal Medicine, 2002-11-19 00:00:00.0; 137(10), p. 783-90.
PMID: 12435214
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Measuring breast, colorectal, and prostate cancer screening with medicare claims data.
Authors: Freeman J.L. , Klabunde C.N. , Schussler N. , Warren J.L. , Virnig B.A. , Cooper G.S. .
Source: Medical Care, 2002 Aug; 40(8 Suppl), p. IV-36-42.
PMID: 12187166
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Studying radiation therapy using SEER-Medicare-linked data.
Authors: Virnig B.A. , Warren J.L. , Cooper G.S. , Klabunde C.N. , Schussler N. , Freeman J. .
Source: Medical Care, 2002 Aug; 40(8 Suppl), p. IV-49-54.
PMID: 12187168
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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 D.D. , Zhou X.H. , Freeman D.H. , Freeman J.L. .
Source: Statistics In Medicine, 2002-03-15 00:00:00.0; 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 J.L. , Warren J.L. , Nattinger A.B. , Zhang D. , Goodwin J.S. .
Source: Medical Care, 2000 Jul; 38(7), p. 719-27.
PMID: 10901355
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An approach to identifying incident breast cancer cases using Medicare claims data.
Authors: Freeman J.L. , Zhang D. , Freeman D.H. , Goodwin J.S. .
Source: Journal Of Clinical Epidemiology, 2000 Jun; 53(6), p. 605-14.
PMID: 10880779
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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 J.L. , Goodwin J.S. .
Source: Journal Of Clinical Epidemiology, 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 J.L. , Goodwin J.S. .
Source: Breast Cancer Research And Treatment, 1999 Jan; 53(2), p. 137-44.
PMID: 10326790
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