Research Appraisalobservational

Comparing endocrine therapy adherence across EHR and claims data by race and ethnicity, language, and insurance.

Cancer causes & control : CCCSodipo, Michelle O, Morgans, Alicia K, Mucci, Lorelei A et al.3 Apr 2026DOI

Clinical Snapshot

70CEBM

Evidence: Weakobservational

PICO Framework

P — Population	79 HR+ breast cancer survivors receiving care at Massachusetts General Hospital
I — Intervention	Electronic health records (EHR) data for adherence measurement
C — Comparator	Claims data for adherence measurement
O — Outcomes	Medication adherence measured by medication possession ratio (MPR) and proportion of days covered (PDC), time to first non-adherence, time to discontinuation

Bottom Line

This small comparative study suggests that electronic health records overestimate endocrine therapy adherence compared to claims data in breast cancer survivors, with variations by demographic factors. While the finding that prescription records don't equal prescription fills is unsurprising, the study highlights important measurement considerations for adherence research. However, the small sample size (75 patients) and single-centre design limit generalisability. For Australian clinicians, the findings suggest caution in interpreting adherence data from different sources, though the US insurance-based claims system differs substantially from our PBS/Medicare structure. The study's value lies more in methodological insights than direct clinical application, emphasising the need for multiple data sources when assessing medication adherence in diverse patient populations.

Evidence: Weak

Key Findings

P Value: Not reported
Effect Size: Not specified in abstract
Primary Outcome: Positive correlation between EHR and claims-based adherence measures
Nnt Or Sensitivity: EHR data overestimated adherence compared to claims data
Confidence Interval: Not reported

Clinical Application

Requires access to both EHR and administrative claims data Limited applicability due to different healthcare system; PBS data might serve similar role to US claims data, but private health insurance structures differ significantly HR+ breast cancer patients on endocrine therapy, particularly in diverse populations

Abstract

PURPOSE: We compared adherence measurements across electronic health records (EHRs) and claims data for 79 HR + breast cancer survivors, considering their race, ethnicity, language, and insurance status. METHODS: Adherence was evaluated using the medication possession ratio (MPR) and proportion of days covered (PDC). The correlation between EHR and claims data was assessed with Spearman correlation coefficients, while Kaplan-Meier curves were employed to visualize and analyze the time to the first instance of non-adherence and the time to discontinuation. RESULTS: A total of 75 breast cancer patients receiving care at Massachusetts General Hospital (MGH) were identified. While there was a positive correlation, EHR data tended to overestimate adherence based on medication prescriptions, while claims data captured adherence through prescription fills. Kaplan-Meier analyses demonstrated differences in the time to first non-adherence between EHR and claims data sources, with observed variations based on language and insurance status. CONCLUSION: Our findings suggest that EHR and claims data offer complementary insights into adherence measurement, and their integration could improve adherence assessment across diverse populations.

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