Casefinding follow up
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Casefinding & Follow-Up. Dolores E. McCord, RHIT, CTR Piedmont Hospital Atlanta, Georgia. Follow-Up and Casefinding. Inter-related Procedures Casefinding leads to follow-up Follow-up leads to casefinding. Casefinding – Sources. No casefinding, no registry Pathology Department – a MUST

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Casefinding & Follow-Up

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Casefinding follow up

Casefinding & Follow-Up

Dolores E. McCord, RHIT, CTR

Piedmont Hospital

Atlanta, Georgia


Follow up and casefinding

Follow-Up and Casefinding

  • Inter-related Procedures

    • Casefinding leads to follow-up

    • Follow-up leads to casefinding

2004 GATRA Educational Conference


Casefinding sources

Casefinding – Sources

  • No casefinding, no registry

    • Pathology Department – a MUST

      • Surgical reports

        • Hospital patient

        • Physician office

        • Path only

      • Cytology

      • Bone marrows

      • Autopsy Reports

2004 GATRA Educational Conference


Casefinding sources1

Casefinding – Sources

  • No casefinding, no registry

    • Medical Record Indices – a MUST

    • Outpatient Departments

      • Radiation Therapy

      • Infusion Therapy / Chemotherapy

    • Others?

2004 GATRA Educational Conference


Casefinding

Casefinding

  • Multiple sources – to find

    • Nothing

    • New patient, new diagnosis

    • Existing patient, new diagnosis, follow-up of existing diagnosis

    • Existing patient, existing diagnosis, recurrent or progression, follow-up

    • Existing patient, existing diagnosis, no change, follow-up

2004 GATRA Educational Conference


Casefinding1

Casefinding

  • History of, existing cases – trouble-makers

    • Why patient in hospital system with cancer codes?

    • What if the biopsy was negative? What were they trying to find?

      • Ruling out presence of cancer?

      • Trying to confirm presence of cancer, suspected?

    • What about x-rays, scans? What are they looking for?

    • Bigger question: How far do you go?

2004 GATRA Educational Conference


Follow up

Follow-Up

  • The reason the hospital registry exists.

    • Finds recurrences and new primaries for existing patients

    • Requires resources, time, and diligence.

    • Provides the real value for registry: patient outcome.

2004 GATRA Educational Conference


Follow up1

Follow-Up

  • Is the patient still alive?

    • Simple question – answered,

      • Yes

      • No.

  • The patient is dead – end of story?

    • ICD Cause of Death: to code or not to code. That is the question.

2004 GATRA Educational Conference


Follow up2

Follow-Up

  • Is the cancer present, or was present at last contact/death?

    • Not so simple.

    • Never Disease-Free Cancers: Unknown Primaries, distant metastases at diagnosis.

      • Can the cancer go away?

      • Is the patient clinically without evidence of disease – per physician?

    • Recurrent Cancers: did treatment eradicate all cancer?

2004 GATRA Educational Conference


Follow up3

Follow-Up

  • Cancer status: 1, 2, or 9?

    • Last follow-up, cancer status: 1

    • Next follow-up, cancer status: 1?

      • Any evidence for recurrence?

      • Questionable status – rising markers, uncertainty

2004 GATRA Educational Conference


Follow up4

Follow-Up

  • Cancer status: 1, 2, or 9?

    • Last follow-up, cancer status: 2

    • Next follow-up, cancer status: 2?

      • Did treatment eradicate all evidence of cancer?

      • Where did it go?

2004 GATRA Educational Conference


Follow up5

Follow-Up

  • Cancer status 1, 2, or 9?

    • Last follow-up, cancer status: 9

    • Next follow-up, cancer status: __?

2004 GATRA Educational Conference


Follow up6

Follow-Up

  • COC Requirements

    • Patient status

    • Cancer status

    • Recurrence information

2004 GATRA Educational Conference


Follow up7

Follow-Up

  • Not Required by COC

    • Subsequent treatment

    • Specific metastatic site(s)

2004 GATRA Educational Conference


Follow up8

Follow-Up

  • Subsequent treatment – completes the picture

    • Recurrences – what happened next?

    • Non-analytic cases – was cancer care given?

    • Biopsy? More surgery? Radiation? Chemotherapy? Palliative care?

    • Administrative reports – radiation, 1st or 2nd course – a must!

2004 GATRA Educational Conference


Follow up9

Follow-Up

  • Recurrence information – Metastatic Sites

    • Single site, specific code

    • Multiple sites, combination code – lose information

      • Brain mets, at DX and at recurrence – administrative reports

2004 GATRA Educational Conference


Follow up process

Follow-Up Process

  • Steps = Success

    • List due for follow-up

      • Hospital system: inpatients, outpatients, ED

      • MQS

      • SSDI

      • Other?

2004 GATRA Educational Conference


Follow up process1

Follow-Up Process

  • Steps = Success

    • Letters

      • Physicians: one vs. all

      • Patients

      • Other physicians?

      • Secondary contacts?

    • Last resorts – the phone

2004 GATRA Educational Conference


Follow up letters

Follow-Up Letters

  • Patient Letters

    • Valuable information

    • New doctors

    • New address

    • Date of last contact – post mark date

    • Returned – Pain in the ____!

      • MLNA – address search

      • New address

2004 GATRA Educational Conference


Follow up letters1

Follow-Up Letters

  • Physician Letters

    • Not always reliable

    • Wrong dates, unknown info

    • Source for other physicians

    • Recurrence and subsequent treatment information

    • Clinical trial inclusion

    • Keep physician contacts updated

2004 GATRA Educational Conference


Follow up letters2

Follow-Up Letters

  • Other Contact Letters

    • Rarely used

    • Varied response rates

    • Could be useful

2004 GATRA Educational Conference


Follow up sources

Follow-Up Sources

  • Letters / Phone calls

  • Admissions / hospital service (CF)

  • Path reports (CF)

  • Clinic / outpatient visits (CF)

  • Internet sources

  • Death certificates

  • Obits

2004 GATRA Educational Conference


Follow up rates

Follow-Up Rates

  • Two Measurements

    • Since reference date: 80%

    • Diagnosed last 5 years: 90%

    • No longer 80% of alive analytic patients

    • No longer 90% of all analytic patients

2004 GATRA Educational Conference


Follow up rates1

Follow-Up Rates

  • Who are not followed?

    • Non-analytic cases

    • CIS, CIN III, other III’s

    • Previously collected localized skins

    • Benign / borderline tumors

    • Foreign residents

    • Reportable by agreement

    • >100 years old, last contact >12 months

2004 GATRA Educational Conference


Follow up rates2

Follow-Up Rates

  • Who are lost?

    • “…delinquent if no contact has been made with the patient within fifteen months after the date of last contact.”

      • Hutchison, C.L., S.D. Roffers, and A.G. Fritz (eds.), Cancer registry management: principles and practice. Dubuque: Kendall/Hunt Publishing Company, 1997, p. 137.

2004 GATRA Educational Conference


Follow up rates3

Follow-Up Rates

  • Who are lost?

    • Last Contact: June 2003

    • 12 months:June 2004

    • 13 months:July 2004

    • 14 months:August 2004

    • 15 months:September 2004

    • Lost 16 months:October 2004

2004 GATRA Educational Conference


Follow up rates4

Follow-Up Rates

  • Who are lost?

  • Current month:October 2004

  • 12 months back:October 2003

  • 13 months back:September 2003

  • 14 months back:August 2003

  • 15 months back:July 2003

  • 16 months & lost:June 2003 & before

2004 GATRA Educational Conference


Casefinding and follow up

Casefinding and Follow-Up

  • Made for each other!

    • One should always lead to the other.

    • Both time-consuming processes

    • Both basis for registry

2004 GATRA Educational Conference


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