An#Algorithm#to#Iden/fy#Delivery#of#Pallia/ve# - - PowerPoint PPT Presentation

E Onukwugha1, J Gardner1, J Jayasekera1, S Malik2, CD Mullins1, A Valderama3, A Hussain4

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!

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#

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!

• 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.!!!

!

Ra/onale!

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…!

15!

HCPCS#Code# Descrip/on# 77402# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel!

• pposed!ports,!simple!blocks!or!no!blocks;!up!to!5!MeV!

77403# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel!

• pposed!ports,!simple!blocks!or!no!blocks;!6810!MeV!

77404# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel!

• pposed!ports,!simple!blocks!or!no!blocks;!11819!MeV!

77406# Radia/on!treatment!delivery,!single!treatment!area,!single!port!or!parallel!

• pposed!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!

Objec/ve#

3!

• 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.!

! ! !

Objec/ve!

17!

Dataset : Linked Surveillance, Epidemiology and End Results (SEER)- Medicare database.

8!

Overview#of#SEERZMedicare#

SEER8 Medicare!

SEER!

8!Cancer#registry#data# 8!Cause!of!death! 8!Area!characteris/cs! 8!Cases!from!197382009!

Medicare!

8!Health!Care!claims!! 8!Treatment!dates! 8!Cost!data! 8!Claims!from!1991!to!2010!

• 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!

Methods!–!Data!source!

20!

• 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!

Methods!–!Measures!

21!

• 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!

Methods!–!Newer!cut!of!data!

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!