Revista de medicina y práctica oncológica

Physicians’ Assessment of Cancer Comorbidity Collection Methods: A Qualitative Analysis

Abstract

Stoner BP, Chandler Ezell K, Biswas B, Kallogjeri D and Piccirillo JF

Objective: We conducted a qualitative assessment of oncologists’ preferences for comorbidity capture methods comparing the ICD-9 claims-based approach to the Adult Comorbidity Evaluation-27 (ACE-27) record abstraction approach. Materials and Methods: Building upon theoretical foundations in anthropology, we developed a qualitative methodology to elicit the thoughts and reactions of 21 practicing oncologists about their preferences for claims-based vs. record-abstraction methods of capturing comorbidity. Grounded theory approach was used to identify recurring themes and dominant concerns expressed by multiple respondents. Codes were developed and applied in two phases: initial and focused. Results: Thematic analysis of qualitative interviews revealed five key domains of concern: accuracy, specificity, utility, robustness and the ease of use of the information for clinical decision-making. There was a strong preference among physician respondents for comorbidity information captured through chart abstraction methods such as the ACE-27. Most respondents felt that claims-based comorbidity data, although easy to capture in the process of billing and coding medical encounters, generally lacked a level of specificity and robustness, thereby rendering the information less clinically useful. Conclusion: For complex, chronic conditions, claims-based comorbidity was seen by respondents as superficial, nonspecific and at times inaccurate in which case medical record abstraction data would be preferred.