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Back to 2017 Program


Leveraging Big Data to Study Bladder Cancer Care
Florian R. Schroeck, MD, MS1, Brenda Sirovich, MD, MS2, John D. Seigne, MBBS3, Douglas J. Robertson, MD, MPH2, Philip P. Goodney, MD, MS2.
1White River Junction VA Medical Center, White River Junction, VT, and Section of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA, 2White River Junction VA Medical Center, White River Junction, VT, USA, 3Section of Urology and Norris Cotton Cancer Center, Dartmouth Hitchcock Medical Center, Lebanon, NH, USA.

BACKGROUND: Despite the high prevalence of bladder cancer, research on optimal bladder cancer care is limited. One way to advance observational research on care is to use linked data from multiple sources. Such “big data” research can provide real-world details of care and outcomes across a large number of patients. We assembled such data including (1) administrative data from the Department of Veterans Affairs (VA), (2) Medicare claims, (3) data abstracted by tumor registrars, (4) data abstracted via chart review from the national electronic health record, and (5) full text pathology reports. Based on these combined data, we validated the use of administrative data to identify newly diagnosed bladder cancer patients who received care in the VA.
METHODS: We used administrative data to identify patients with newly diagnosed bladder cancer between 2005 and 2011 who received care in the VA. To validate these data, we first compared the diagnosis date from the administrative data to that from the tumor registry (gold standard). Second, we measured accuracy of identifying bladder cancer care in VA administrative data, using a random chart review (n=100) as gold standard. Lastly, we compared the proportion of patients who received bladder cancer care in VA among those who did versus did not have full text bladder pathology reports available, expecting that those with reports are significantly more likely to receive care in VA.
RESULTS: Out of 26,675 patients, 11,323 (42%) had tumor registry data available. 90% of these patients had a difference ≤90 days between the diagnosis dates from administrative and registry data. When comparing administrative data to chart review, 58 out of 59 patients who received bladder cancer care in VA were correctly identified (accuracy 95%, sensitivity 98%, specificity 90%). As expected, receipt of bladder cancer care in VA was substantially more common among those who had bladder pathology reports available versus those who had not (96% vs 43%, p<0.001).
CONCLUSIONS: We successfully combined administrative data with tumor registry, electronic health record, and pathology data (Figure) and validated the resultant data set. This validated data set will now make it possible to better understand how bladder cancer care is currently provided and how intensity of care impacts outcomes such as tumor recurrence and progression.


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