QUALITY CONTROL OF CANCER REGISTRY DATA

1. QUALITY CONTROL OF CANCER REGISTRY DATA Valerie Vesich, RHIT, CTR Seton Healthcare Family TXTRA – September 26, 2012

8. Qualilty….What comes to mind? • When you hear the word ‘quality’ • Something that is made WELL- using the best products • Something that is done according to the way it should be done • An outstanding end-product • Quality- Merriam Webster -qual-i-ty (kwäl-ət-ē\) • A special or distinguishing attribute

9. Control--VERB • Merriam-Webster – con-trol \kən-trōl • To reduce the incidence or severity of especially • 1--aarchaic: to check, test, or verify by evidence or experiments b: to incorporate suitable controls in <a controlled experiment> • 2--a: to exercise restraining or directing influence over :regulateb: to have power over :rulec: to reduce the incidence or severity… of something especially to innocuous levels <control a disease>

10. You have a new car……

11. You hit a tree

12. Go to auto body shop *****

13. What went wrong? Mgr, staff??

14. Here’s another example…. Mila Kunis- “Black Swan” Courtesy of IMDb

15. The color charts are mislabled… Lucille Ball 1962 Courtesy IMDb

16. Request from Physician….. What happens when things seem wrong? Physician makes a request for a listing of the extra-lymphatic lymphomas for the last five years. Mainly interested in extra-nodal disease to the breast (male/female). He knows there have been a number of cases from your facility as he has treated cases.

17. Begin to run some reports

18. Extraction Results No extra-nodal lymphomas to the breast What could be happening here?

19. How can we solve the problem?

20. Today • Hope to send a ‘take home’ message • Who sets the standards for registry quality control of data? • How to develop your Quality Control Plan? • Example of Quality Control studies • How to solve quality issues?

21. Right and a Wrong Way • Fear- we get all emotional with the thought of someone looking at our work • Wrong • “You are always making this error” • I told you the correct way and you are still doing it wrong • Right • Let’s try to see how we can code this correctly • Let’s understand why we need to do this

22. Skills needed to monitor quality People deserve respect – supervisors, registrars Coach and Develop- Training Drive Performance – Setting performance expectations Inspire Loyalty and Trust = employees who care Partner Within Registry – build team effort Influence – through positive power

23. Setting Expectations Understanding- that work will be measured Alignment – Expectations link us to the organizational objectives Agreement – Expectations are within each of us, actions are clear, work towards progress and achievement

24. Expectations Be open- purpose and importance Clarify – proposed expectation Develop – quality control plan Agree- tracking methods Close - confirm confidence

25. Let’s all be STAR’s today Situation or Task (S/T) (data abstracting quality) issues or on track for consistency Action (A): What we can do to make quality control part of each day, each abstract Result (R): What will be the result of our action? Enhanced Result (R): What is the result of fixing a quality issues?

26. Knowing Traps and How to Avoid Focusing on productivity not quality Coding pathways Memorizing cancer registry codes Scanning reports and not reading Incomplete or inadequate documentation

27. Travel with Key Principles Offer the ‘whys’ Ask others to participate in a plan Remember Facts and Feelings go together Don’t jump to conclusions – Help others think and do Ask for ideas first Be Positive Make sure experiences supplement

28. Why??? Cancer Information in the News Everyday Folks are living longer with cancer According to CDC- “More Americans Surviving Cancer How do they know this? It is because of us

29. Quality Control vs Quality Assurance Quality Control- mechanics of improving quality Quality Assurance – Organizations broader philosophical approach to quality

30. Quality Control Assures • Published Data, Annual Reports, Assessment of Treatment Planning • Fundamental intent of registry work is correct • Is data from registry reproducing the product accurately? • End product is useful

31. Quality Control- Most Important • To affect any kind of change---what needs to happen • Communication • Feedback

32. IMPORTANT– WHYREPORTING OF DATA • CANCER PROGRAM APPROVAL COMMISSION ON CANCER • FORDS • NCDB • STATE REPORTING • CASEFINDING • CDC-SEER, NPCR-CDC—AMERICAN CANCER SOCIETY

33. COMMISSION ON CANCER 1.6 Quality Control Plan- Minimum of what is required to be viewed = 10% Maximum: 300 cases annually Random Sampling Physician Reviewers Specifics on what areas of abstract need quality review Survey- review plan, minutes/documentation, resolution

34. QUALITY CONTROL COORDINATOR STD 1.2 • Cancer Registry Quality Coordinator • Cancer Registrar –Yeah- we can fulfill this role • Conducting activity • Reporting the outcomes- annually • Recommend corrective action • Documentation

35. Eligibility Requirement E5Quality Control (QC) Plan • Part of the Cancer Registry Policy and Procedure • Cancer Committee Reviews and Approve • Document, document, document

36. Keeping Notes – • Keeping good notes of what happens throughout the year • Paper • Electronic • Keeping a journal

37. How to start Go Green: Keep all files electronic Be Specific- But leave room for adjustments Make it a yearly plan Comprehensive- all staff is involved Monitoring activities – all areas of registry Not just data collection Quality control of registry operations vs quality control of registry data

38. The Plan- Include… • Include ways to evaluate processes- • Involve Registry Staff • Matrix and Flow Charts • Solving quality problems and improving processes • Quality Characteristics-Accuracy/data completeness • Acceptance Sampling- visual review, edits, casefinding

39. The Plan: Include….. • Process Control- how each process/study or studies will it be done • Make sure to name/label each process/study and attach to your plan • Setting Benchmarks- what is the required percentage for accuracy • NCDB – 100% of all cases are error free • Percentage rate for Casefinding 95-98% • Registrar review 95% • Physician review 95%

40. Studies/projects • Name and date it • Set the review criteria • Set the quality control timetable • Set the specifics: methods, sources and individuals • Required • Random sampling- • Physician review • Other- State audits

41. Processes that could be QC Conference Activity TNM Staging Treatment Planning Running reports for physicians and issues are found Simple issues count too

42. Criteria • Data Item Selection • Clear definitions • Clear definitions can be collected poorly • Conformance..product adheres to the design specifications and tolerances • Conformance of the data in the record and the data recorded by the registrar

43. Remember.. Examples of Review- • Registrar or Physician Methods • Visual review of abstract – on line, printed abs • Use Random selection of cases from a master list • Visual review of abstract and patient record • Use Random…. • Visual review of a specified listing

44. Reviews: Data Completeness Comprehensiveness of data collected Text Documentation Unknown Values

45. Activity: Accuracy of Abstracted Data • Timeliness of Abstracting • Class of Case • Primary Site • Histology • AJCC Stage • Collaborative Stage • First Course of Treatment • Follow-up: Recurrence type, Ca Status

46. Class of Case • Accuracy in coding the correct class of case • Date of first contact to facility, date of diagnosis, date of first course of therapy and place of first course of therapy • Comparing ‘00’ vs ‘10’ example

47. Primary Site Run reports on sites evaluating coding the third digit as unknown (especially in breast, colon, lung) Text in abstract should support coding

48. Histology Lymphomas Run reports on coded histologies against text

49. AJCC Stage Compare AJCC with CS Look for Unknowns when CS is done AJCC T-N-M- compare T with tumor size (for certain sites such as breast, lung, etc) Cases staged as unknown

50. Collaborative Stage Compare with Physician’s AJCC Stage List out tumor size, extension (description) Make review of CS simple for physicians and more detailed when registrars do review