Quality Control in the Hospital Registry

Kimberly DeWolfe, MS, CTR

Quality Coordinator

Oncology Data Center

GATRA

September 27, 2013

Overview

• Who are your customers?

• Strategies to ensure high quality data

• The Quality vs. Quantity struggle

• QC for the future

You Hold the Key

• The Cancer Registry is the cornerstone of your Cancer Program

• Your data is more powerful than you think

• Take pride in your work

Text Text Text

• Your work has a ripple effect

• Your text is your source documentation

• More and more people are finding a use for it

• Research is at the forefront

External Customers

• Accrediting Agencies

–American College of Surgeons

• CoC

• NAPBC

• SEER/NPCR

• Georgia Comprehensive Cancer Registry

• Georgica Center for Cancer Statistics

CoC Quality Improvement Measures

• NCDB

• RQRS

• QOPI

• PQRS

– Compliance with these measures keeps you ahead of the curve

– You become an active participant in patient care

• Physicians

• Administrators

• Other Departments

• Abstractors

Internal Customers

Keep your customers in mind

• Are you meeting their requirements?

• Are you meeting their needs?

• How can you accommodate them in the future?

Requirement Differences

• Check the SEER Manual against the FORDS Manual

– There are differences in grading rules

• FORDS does not require grade when a specialized grading system applies

• SEER requires both grades

• Refer to the SEER Manual and Appendix C for details

Strategies for High Quality Data

Be Proactive

• Maintain day-to-day and quarterly QC activities

• Ask for help

• Utilize technology to the fullest extent

It’s no fun putting out fires

Day-to-Day QC

• Check your abstractors’ work

– Devise a quality form that tracks accuracy rate

– Designate critical and minor errors and weight accordingly

• Keep employees up to date on changes

– Be creative with in-services; make them interactive

• Identify areas for improvement

– What trends are you observing?

– This can dictate the content of your in-services

Day-to-Day QC

• Change the way you view your data –Print out paper abstracts and reports

–View the same data set in list and graph format

• Utilize your strong abstractors –Lean on your seasoned CTR to act as your quality control designee

–Use them as an objective eye to view reports; a good way to involve the frontline employee

Day-to-Day QC

• Catch problems when small

• Run weekly reports on specific factors – Query non-analytic cases

– Query class of case 20’s

– Query rare or less frequent primary sites

Day-to-Day QC

• Query “none” in the treatment text sections

– Search for reasons the patient was not treated

• Query 9’s to determine if your physician or hospital directories are outdated

– The key to your follow-up and referral pattern success

Quarterly QC Using Reports

• Cross-check reports

– Coded fields vs. text fields

• Conditional reports

– If… then scenarios

• Treatment reports

– Newer or less frequent techniques

Cross Checks

Code vs. Text Cross Check

• Do your HER2 results match the lab text?

– HER2 code = 020/negative

– Text indicates patient is HER2 positive

• Do you have surgery, NOS codes when text specifies a better procedure?

– Code 20 = Partial mastectomy, NOS

– Your text states Lumpectomy, which is a code 22

Breast Primaries

Code vs. Text Cross Check

• T stage vs. Radiology text

• Do you have the best T or CS extent stage based on the radiology findings?

• Do you have scope text to justify your stage?

– Bronchoscopy findings are often omitted from text

– Extrinsic or obstructive findings are key factors when assigning clinical T and CS extent stage

Lung Primaries

Code vs. Text Cross Check

• Gleason Score in SSF section vs. Grade field and grade text

• Does your Gleason Score convert correctly to the grade field?

• Does your coded Gleason Score and Patterns match your text?

Prostate Primaries

Code vs. Text Cross Check

• Check your radiation codes against beam and other xrt text

• New radiation treatments are difficult to code

– Our fields are outdated for the new techniques

– Establish a department procedure for the newer xrt techniques

– Consistency is key

Radiation Fields

If….Then Scenarios

If….Then Scenarios

• If reason no chemo = 1, then chemo start date must be blank

• If neoadjuvant therapy given, then TNM descriptor must = Y

– Query your eval codes 5 and 6 to identify

For All Primaries

If….Then Scenarios

• If ER/PR positive, then hormone fields cannot= blank

• If SSF 7 (BR Score for breast) = 3-9, then grade field cannot = 9

• If lymph nodes are only evaluated clinically without path confirmation, then SSF 19 must = 015 or 010

Breast Primaries

If…Then Scenarios

• If a patient has a TURP, then the CS extent code should reflect this (do not use 150)

• If CS Extent Code = 150, then CS TS/Ext Eval code must = 1

• When prostatectomy is not performed, then SSFs 9,10, and 11 should = 998

Prostate Primaries

If…Then Scenarios

• Compare surgical codes to SSF2

• If surgery is less than a wedge resection (code 20), then SSF 2 must = 998

Lung Primaries

If…Then Scenarios

• Papillary carcinoma of the thyroid is coded to 8260 and not 8050 per histology rules 14 and 26

– How many have you coded incorrectly in your registry?

Thyroid Primaries

If…Then Scenarios

• Review your stage II-IV lymphoma cases with a primary site code assigned as C77.9

– Per Module 7 in the Hemato Manual, rule PH30 instructs you to code the primary site to C77.8 when multiple lymph node regions are involved and it is not possible to identify the lymph node region where the disease originated

Hematopoietic and Lymphoid Primaries

Treatment Reports

• Brachy therapy codes

–For your rare procedures

• Immunotherapy codes

–2012 vs. 2013 to determine if abstractors are following the SEER*Rx category changes

• Surgery Codes

–Codes ending in 0 for sites with more specific codes

Ask for help

• Seek input from physicians – What needs aren’t we meeting?

– How can we fix that? Concurrent abstracting?

• Ask your regional coordinator about quality checks routinely run in the state registry – You could do the same

• Utilize the GCCS and NCDB completeness reports – Identifies blanks, unknown and unspecific values

Quality vs. Quantity

Tug of War

Quality vs. Quantity

• How do you balance the two?

• Designate different times each week/month for each

• Assess your resources

• Set goals

– At the end of Fiscal Year 2014 we will have a 95% accuracy rate and be concurrently abstracting all major sites

Take Advantage of Technology

• Interface with all hospital-owned databases

• Attend registry software user meetings

• Request custom QC reports from your software vendor

QC in the Future

QC in the Future

• CS Coding going away for 1/1/2016 Cases

– Per SEER and NPCR requirements

• What should be the new focus?

– AJCC staging

– Prognostic factors

– Recurrence information

Summary

• Who are your customers?

• Strategies for high quality data

• Quality vs. Quantity struggle

• Looking toward the future

Questions?