An#Algorithm#to#Iden/fy#Delivery#of#Pallia/ve# Radia/on#Therapy#Using#Health#Care#Claims#Data:# A#Proof#of#Concept#Applica/on#of#Data# Visualiza/on#Tools#in#the#Prostate#Cancer#SeCng# E Onukwugha 1 , J Gardner 1 , J Jayasekera 1 , S Malik 2 , CD Mullins 1 , A Valderama 3 , A Hussain 4 1 University of Maryland School of Pharmacy 2 University of Maryland College Park, HCIL 3 Bayer Healthcare Pharmaceuticals 4 University of Maryland School of Medicine !
Acknowledgements# • Bayer!Healthcare!Pharmaceu/cals,!Inc.! • Center!for!Health8related!Informa/cs!and!!Bioimaging! • UMB:! – Owen!White,!MD,!UM!School!of!Medicine! – Candice!Yong,!PhD!candidate,!UMSOP! – Chris/ne!Franey,!Pharmaceu/cal!Research!Compu/ng,!UMSOP! • UMCP,!Human8Computer!Interac/on!Lab!(HCIL),!UMIACS!&! Dept!of!Computer!Science:!! – Amitabh!Varshney,!PhD,!UMCP! – Ben!Shneiderman,!PhD,!UMCP! – Catherine!Plaisant,!PhD,!UMCP! 1!
Prior!work!using!EventFlow!
EventFlow#implementa/on#case#no.1:## Warfarin#usage#before#and#aLer#trauma/c#brain#injury# Data:!Medicare!Claims!data,!NIH!R21:!Long8term!an/coagula/on!therapy!aUer! ! trauma/c!brain!injury!in!older!adults!(5R21AG042768802)! Aim:!to!examine!warfarin!usage!pa_erns!among!elderly!atrial!fibrilla/on!pa/ents! ! who!suffered!trauma/c!brain!injury! Methods:!pa/ents!grouped!and!sorted!by!dis/nct!event!sequence!before!and!aUer! ! injury!(warfarin!usage:!yes,!no,!or!missing)! Events!are!color!coded!bars! ! Height!of!the!bar!represents!number!of!pa/ents! ! The!horizontal!gap!between!bars!represents!the! average !/me!between!two!adjacent!events! ! Findings:!the!prevalence!of!warfarin!use!in!elderly!AF!pa/ents!decreased!aUer!TBI!! ! �
# EventFlow#implementa/on#case#no.2:## Varia/on#in#the#Length#of#Radia/on#Therapy#among#Men#Diagnosed#with# Incident#Metasta/c#Prostate#Cancer# Background:## # Radia/on!therapy!to!the!bone!(R_B)!is!a!common!skeletal8related!event!(SRE)! • experienced!by!prostate!cancer!pa/ents!with!bone!metastasis.!! Codes!available!in!claims!data!cannot!dis/nguish!R_B!from!radia/on!to!the! • prostate!gland!(R_P),!and!may!therefore!overes/mate!R_B.!! ! Objec/ve:## Recognizing!that!the!course!of!therapy!for!R_B!is!typically!shorter!than!the! • course!for!R_P,!we!examined!the!varia/on!in!length!of!radia/on!treatment! episodes!among!pa/ents!diagnosed!with!metasta/c!(M1)!prostate!cancer! (PCa),!compared!to!pa/ents!with!stage!4!non8metasta/c!(M0)!PCa.!! ! Results:# • The!majority!of!radia/on!episodes!among!M1!pa/ents!were!of!short!dura/on! (<4!weeks).!In!the!majority!of!M0!pa/ents,!the!ini/al!radia/on!episodes! following!diagnosis!of!PCa!were!of!longer!dura/on!(>6!weeks).! • SREs!occurred!sooner!aUer!PCa!diagnosis!among!M1!pa/ents!compared!to!M0! pa/ents.!Among!M1!pa/ents,!radia/on!episodes!following!an!SRE!were!more! likely!to!be!of!shorter!dura/on!than!longer!dura/on.! !
Case#Study## #An#Algorithm#to#Iden/fy#Delivery#of#Pallia/ve#Radia/on# Therapy#Using#Health#Care#Claims#Data:## A#Proof#of#Concept#Applica/on#of## Data#Visualiza/on#Tools#in#the## Prostate#Cancer#SeCng# 2!
Background# 3!
Background! • Bone!is!a!common!site!of!metastasis!among! individuals!with!solid!tumors.!! – For!example,!breast,!prostate,!and!lung!cancers.! ! • Pa/ents!with!bone!metastasis!(BM)!are!at!risk!of! skeletal8related!events!(SRE).! ! • SREs!have!a!nega/ve!impact!on!health.! 10!
Skeletal#related#events# • Skeletal!complica/ons!are!associated!with!! – morbidity! – poor!health8related!quality!of!life! – reduced!survival! • Nearly!two!thirds!of!the!men!diagnosed!with!PCa!in! the!United!States!are!aged!65!years!or!older!and!are! at!increased!risk!of!skeletal!related!events!(SREs).!! 4!
Ra/onale! • Skeletal8related!events!(SRE)!include:! • Pathological!fracture!(PF)! • Spinal!cord!compression!(SCC)! • Bone!surgery!(BS)! • Radia/on!to!the!bone!(R_B)! • Issue:! • Codes!available!in!claims!data!cannot!dis/nguish!R_B! from!radia/on!to!the!prostate!gland!(R_P),!and!may! therefore!overes/mate!R_B.!!! ! 12!
Measurement! • Reliable!measures!for!iden/fying!the! components!of!SREs!are!cri/cal.! • Studies!using!healthcare!claims!employ! various!algorithms!to!iden/fy!R_B.! – Condi/on!on!prior!claims!with!a!bone!metastasis! code! – Concerns!regarding!sensi/vity!!and!specificity!of! diagnosis!codes!
A!look!at!radia/on!codes…!
HCPCS#Code# Descrip/on# 77402# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel! opposed!ports,!simple!blocks!or!no!blocks;!up!to!5!MeV! 77403# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel! opposed!ports,!simple!blocks!or!no!blocks;!6810!MeV! 77404# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel! opposed!ports,!simple!blocks!or!no!blocks;!11819!MeV! 77406# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel! opposed!ports,!simple!blocks!or!no!blocks;!20!MeV!or!greater! 77407# Radia/on!treatment!delivery,!two!separate!treatment!areas,!three!or!more! ports!on!a!single!treatment!area,!use!of!mul/ple!blocks;!up!to!5!MeV! 77408# Radia/on!treatment!delivery,!two!separate!treatment!areas,!three!or!more! ports!on!a!single!treatment!area,!use!of!mul/ple!blocks;!6810!MeV! 77409# Radia/on!treatment!delivery,!two!separate!treatment!areas,!three!or!more! ports!on!a!single!treatment!area,!use!of!mul/ple!blocks;!11819!MeV! 77411# Radia/on!treatment!delivery,!two!separate!treatment!areas,!three!or!more! ports!on!a!single!treatment!area,!use!of!mul/ple!blocks;!20!MeV!or!greater! 77418# Intensity!modulated!treatment!delivery,!single!or!mul/ple!fields/arcs,!via! narrow!spa/ally!and!temporally!modulated!beams! 15!
Objec/ve# 3!
Objec/ve! • To!examine!the!varia/on!in!the!length!of! radia/on!treatment!episodes!among!pa/ents! diagnosed!with!metasta/c!(M1)!PCa,! comparing!to!pa/ents!with!stage!4!non8 metasta/c!(M0)!PCa.!! • To!determine!the!components!of!a!claims8 based!algorithm!for!iden/fying!pallia/ve! radia/on!therapy.! ! ! ! 17!
Dataset : Linked Surveillance, Epidemiology and End Results (SEER)- Medicare database. 8!
Overview#of#SEERZMedicare# SEER! Medicare! 8! Cancer#registry#data# 8!Health!Care!claims!! 8!Cause!of!death! 8!Treatment!dates! 8!Area!characteris/cs! 8!Cost!data! 8!Cases!from!197382009! 8!Claims!from!1991!to!2010! SEER8 Medicare! ���
Methods!–!Data!source! • Data!source!and!study!cohort:! • Linked!Surveillance,!Epidemiology!and!End!Results! (SEER)!and!Medicare!data! • Pa/ents!aged!66+!with!an!ini/al!diagnosis!of!!! stage!4!PCa!during!2000!8!2007! • Medicare!claims!data!from!1999!to!2009! 20!
Methods!–!Measures! • Outcome! • External!beam!radia/on!therapy!(EBT)!episode!lengths!were!grouped! by!dura/on:! • Less!than!4!weeks! • 486!weeks! • 688!weeks! • Greater!than!8!weeks! ! • Other!events!of!interest! • Prostate!cancer!diagnosis!date! • Treatment!ini/a/on:!Androgen!depriva/on!therapy,!radia/on,! chemotherapy,!radiopharmaceu/cal,!or!intravenous!bisphosphonate! • Other!skeletal8related!events!(SRE)! • Pathological!fracture! • Spinal!cord!compression! • Bone!surgery ! 21!
Methods!–!Newer!cut!of!data! • Data!source!and!study!cohort:! • Linked!Surveillance,!Epidemiology!and!End!Results! (SEER)!and!Medicare!data! • Pa/ents!aged!66+!with!an!ini/al!diagnosis!of!!! stage!4!PCa!during! 2005#Z#2009 ! • Medicare!claims!data!from!1999!to!2010! 22!
Measures!(contd.)! • Patient groups were defined as follows: – C1 : diagnosed with incident bone metastases ; – C2 : diagnosed with incident AJCC stage IV M0 PCa . • RttB was defined as the receipt of external beam radiation therapy, radiopharmaceutical therapy, intensity modulated radiotherapy or stereotactic radiosurgery. • Eventflow visualization software was used to: – compare C1 and C2 in terms of the time from diagnosis to probable RttB, SCC, BS, and PF; – select potential criteria for identifying probable RttB using claims data !
Thank#you!# 29!
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