Evaluation of Claims, Medical Records, and Self-report for Measuring Fecal Occult Blood Testing among Medicare Enrollees in Fee for Service

^{1 1}The Carolinas Center for Medical Excellence, Cary, North Carolina; ²Health Services and Economics Branch, Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland; ³Statistical Research and Applications Branch, Surveillance Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, Maryland; ⁴Division of General Medicine, University of Michigan, Ann Arbor, Michigan; and ⁵Department of Medicine and Cecil Sheps Center for Health Services Research and ⁶Departments of Medicine and Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina

^* To whom correspondence should be addressed. E-mail: aschenck{at}ncqio.sdps.org.

	Abstract

Background: There is no agreement on the best data source for measuring colorectal cancer (CRC) screening. Medicare claims have been used to measure CRC testing but the validity of using claims to measure fecal occult blood tests (FOBT) has not been established.

Methods: We compared ascertainment of FOBT among three data sources: self-reports, Medicare claims, and medical records. Data were collected on FOBT use during the study window (1/1/1998 – 12/31/2002). Our study was conducted with North Carolina Medicare enrollees (N = 561) who had previously responded to a telephone survey on CRC tests. FOBT information was abstracted from respondents' physician office medical records and compared with self-reported FOBT use and Medicare claims for FOBT. Data sources were assessed for accuracy and completeness of FOBT reporting using sensitivity, specificity, positive predictive value, negative predictive value, and agreement.

Results: Reporting of FOBT use in the prior year in medical records and Medicare claims agreed 82% of the time [95% confidence interval (95% CI), 79-85%]. FOBT 1-year use rates from self-report agreed with test use found in medical records 70% of the time (95% CI, 66-74%). The lowest agreement was between self-reported 1-year FOBT use and Medicare claims, which agreed 67% of the time (95% CI, 63-71%).

Conclusions: No data source could be established as providing complete and valid information about FOBT use among Medicare enrollees, showing the difficulty of ascertaining test use rates for noninvasive, low-cost procedures conducted in multiple settings. Caution should be used when attempting to measure FOBT use with self-report, Medicare claims, or medical records. (Cancer Epidemiol Biomarkers Prev 2008;17(4):799–804)

Key Words: colorectal neoplasms, FOBT, medical record audit, self-report, claims, Medicare

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