The Commission on Cancer: Reengineering the National Cancer Data Base

Transcription

1 The Commission on Cancer: Reengineering the National Cancer Data Base Stephen B. Edge MD FACS Chair Commission on Cancer American College of Surgeons Alfiero Chair of Breast Oncology Professor of Surgery and Oncology Roswell Park Cancer Institute University at Buffalo

2 Commission on Cancer Mission Statement The Commission on Cancer is a consortium of professional organizations dedicated to reducing the morbidity and mortality of cancer through education, standard setting, and the monitoring of quality of care.

3 CoC Programs Accreditation (formerly Approval) Physician Liaison Education Quality National Cancer Data Base

4 80% of Cancer in US Treated in Hospitals with approved programs 25% CoC Accredited Programs Treated elsewhere 20% Hospitals without approved programs 75% Diagnosed and treated in approved programs 80% General medical/surgical facilities Including Puerto Rico=~5000

5 CoC Accredited Programs: Primarily Community-Based Teaching 17 Community 35 Community Comprehensive 37 COMP CHCP THCP VACP NCIP NCP Other

6 New Directions for the Accreditation Program Complete revision of standards underway Quality Focus Performance - Based CoC Accreditation Program only national community-based program that has full loop of standards, data collection, and feedback

7 National Cancer Data Base Aggregation of the cancer registry data from CoC accredited programs Objectives Surveillance of cancer incidence Evaluation of patterns of care Active quality management CP3R; E-QuIP Future - Rapid Quality Reporting System (RQRS)

8 Cumulative Cases Reported to NCDB by Diagnosis Year Since 1995, the National Cancer Data Base has captured over 22 million cancer cases Millions Cases '85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

9 National Cancer Data Base Quality Tools NCDB Hospital Comparison Benchmark Reports NCDB Survival Report Cancer Program Practice Profile Reports (CP3R v.2) Rapid Quality Reporting System

10 CoC Survival Reports

11 Registry Activities to Modernize Rapid case ascertainment for quality measurement Rapid case acquisition New quality measures based on guidelines Supplementation with administrative data Payer claims Hospital data Electronic Health Record

12 NCDB: Applying Quality Measures NCDBUsed to establish quality measure NQF Harmonized with ASCO-NCCN measures Application in NCDB For all CoC accredited programs Data provided to programs Increasing level of use and required action

13 Quality Measures and the Commission on Cancer CoC Approvals Program provides a unique national system for application of quality measures Data collection structure Centralized data storage and analysis Existing structure for feedback and reporting to providers Existing program of public reporting

14 Feedback Tools of the NCDB 2004 CP 3 R Chemotherapy with Stage III Colon Cancer 2006 Electronic Quality Improvement Program (equip) 2009: Enhanced CP 3 R 2010: Rapid Quality Reporting System

15 CP 3 R: 2004 Data Reconciliation Periodic Rate Adjustment Facility Specific Data Comparison Data e-quip: 2006 Data Reconciliation Immediate Rate Adjustment Facility Specific Data

16 CP 3 R (v2) Case review and on-line reconciliation: Just like e-quip Comparisons: Just like CP 3 R

17 Rapid Quality Reporting System: Registry based Immediate case acquisition Real-time tracking of care

18 40 FORDS Data Items Assess all Measures FIN Accession Number Sequence Number Patient Zip Code at Dx Class of Case Sex Age Birth Date Diagnosis Date Primary Site Tumor Histology Tumor Behavior Clinical M Clinical Stage Group Pathologic M Pathologic Stage Group Primary Site Surgery Race / Hispanic Origin Primary Payer Clinical T Clinical N Pathologic T Pathologic N Tumor Size Regional Nodes Ex Regional Nodes Pos ERA PRA Cancer Directed Surgery Date Chemotherapy Chemotherapy Date Hormone Therapy Hormone Date Systemic Rx Date Radiation Reg Rx Mod Radiation Date Reason for No Radiation Last Contact Date Vital Status

19

20

21

22

23 66 Test Sites 4 Centers in CT 13 Centers in NJ 16 NCI NCCCP Pilot Sites 27 Centers in GA

24 Linkage of NCDB with Administrative Data Physician records / billing data Other quality projects (e.g. ASCO QOPI) Payer claims Electronic health record Integration with guidelines (NCCN)

25 Enhancing Cancer Registry Treatment Data Through Linkage with Administrative Claims: Case Matching and Surgical Care S Edge 2, K Mallin 1, B Palis 1, A Stewart 1, N Watroba 2, J Roistacher 2, D Walczak 3, J Barron 4, J Rogers 5, W Blumenthal 5 American College of Surgeons (1) Roswell Park Cancer Institute (2) Optum Health (3) Healthcore (4) Centers for Disease Control and Prevention (5) Supported by CDC contract through Northrop Grumman RFP CIO-SP BMH-ACS to American College of Surgeons National Cancer Data Base:

26 Project in Ohio: Goals Establish large scale linkage of private claims to NCDB and OCISS Identify degree of completeness of registry treatment data compared to care identified in claims data Define quality of care Core processes Detailed components of care Provide feedback to CoC programs

27 Claims and NCDB - Ohio: Participants and Scope Aggregated Claims from two payers: United Health Care Anthem Blue Cross Blue Shield Registry Data National Cancer Data Base Ohio Cancer Incidence and Surveillance System Breast, Colorectal, Lung cancer

28 Surgery - Breast Surgery by NCDB Surgery by Claims Surgery Type None BCS Mast Total None / Unk BCS Mastectomy

29 Radiation Therapy - Breast Claims Radiation Administered NCDB - Radiation Administered No Yes Total No Yes Total

30 Chemotherapy - Breast NCDB - Chemotherapy Administered Claims Chemotherapy Administered No Yes Total No Yes Total

31 Endocrine Therapy - Breast Claims Endocrine Administered NCDB - Endocrine Administered No Yes Total No Yes Total (missing 545)

32 Chemotherapy - Colorectal NCDB - Chemotherapy Administered Claims Chemotherapy Administered No Yes Total No Yes Total

33 NQF Quality Measure: Claims vs. Registry

34 Radiation with BCS NQF Quality Measure: RT with BCS within 1 yr of dx Invasive cancer ; Age < 70 NCCN Benchmark 96% BCS by NCDB n = 859 Source of Treatment Data Received Radiation Number Percent NCDB % Claims % Both %

35 Chemotherapy with Estrogen Receptor Negative Cancer NQF Quality Measure: Stage I-III ER negative; Age < 70 Chemo within 120 days of dx NCCN Benchmark 91% N = 266 Source of Treatment Data Received Chemo Number Percent NCDB % Claims % Both %

36 Claims Model Private claims can be linked to the NCDB High level agreement for surgical care Claims provide more complete treatment data for ambulatory care and more granular data Next steps: Evaluation of lung cancer Detailed care processes Extend model All claims states National Realtime claims matching with RQRS model

37 Conclusions: CoC has only existing system for collection of quality data and feedback to providers for quality improvement NCDB requires reengineering for Rapid case identification and accrual Linkage with other sources including claims and EHR

38 Thank you!