Validation of a Claims-Based Algorithm for Specialist Palliative Care Delivery in Metastatic Cancer

Area of Science:

• Health Services Research
• Oncology
• Gerontology

Background:

• Accurate identification of specialist palliative care (PC) delivery in population data is challenging.
• Understanding PC utilization is crucial for improving care for patients with advanced diseases.

Purpose of the Study:

• To develop and validate a claims-based algorithm for identifying specialist PC in Medicare beneficiaries with metastatic cancer.

Main Methods:

• A claims-based algorithm was developed using physician billing claims.
• A known PC clinician's claim served as the gold standard.
• Candidate variables with a positive predictive value (PPV) >60% were retained.

Main Results:

• The algorithm identified specialist PC using "hospice and palliative care" provider codes (PPV 80.4%) or Z51.5 diagnosis codes (PPV 67.5%).
• Patient-level PPV and sensitivity were 78.4% and 88.3%, respectively.
• Bias from algorithm use varied by outcome, with generally acceptable levels.

Conclusions:

• A simple algorithm can reliably identify specialist PC in Medicare claims for metastatic cancer patients.
• The algorithm demonstrates reasonable accuracy and acceptable bias for research purposes.