Validatie van Medicare-maat voor potentieel vermijdbare ziekenhuisbezoeken na chemotherapie

BACKGROUND: Medicare's OP-35 measure tracks unplanned hospital visits within 30 days of chemotherapy and defines a subset as "potentially avoidable" using ∼300 diagnosis codes. Despite widespread adoption in policy and oncology quality reporting, the measure has not been validated with clinician review. METHODS: We identified 14,220 acute hospital visits within 30 days of chemotherapy (2016 to 2023) from 22 hospitals in three health systems (academic, safety-net, community). A 5% stratified random sample of 705 visits underwent blinded review by three clinicians, who adjudicated avoidability and assigned a clinical classification for each visit (eg non-emergent care occurring overnight; non-urgent blood product transfusion; uncontrolled symptoms requiring hospital care). The gold standard definition for an avoidable visit was based on a majority of the clinicians. We assessed the diagnostic characteristics of OP-35 using sensitivity, specificity, accuracy, and area under receiver operator curve (AUROC). We used the clinical classifications to develop a new set of Actionable Categories of avoidability and assessed its diagnostic characteristics. RESULTS: Clinicians judged 30.2% of visits (213/705) as avoidable. OP-35 classified a similar proportion (30.8%, 217/705), but agreement was low. Sensitivity of OP-35 was 34.7% (95% CI, 28.2 to 41.6), specificity 70.9% (95% CI, 66.7 to 74.8), and accuracy 59.9% (95% CI, 56.2 to 63.6), with AUROC of 0.53. The Actionable Categories classification performed better: sensitivity 89.7%, specificity 85.2%, accuracy 86.5%, AUROC 0.87. CONCLUSION: OP-35 showed poor agreement with clinicians for avoidable hospital visits, raising concerns about its clinical validity. An alternative classification system grouping visits into actionable clinical scenarios offered superior diagnostic accuracy.