NPCR CLINICAL EDIT CHECKS FCDS Annual Meeting July 26, 2013 Sunrise, Flrida Steven Peace, CTR FCDS Data Quality Staff
PURPOSE OF CLINICAL EDIT CHECKS The primary purpse f the Clinical Check edits is t evaluate reprted prgnstic and treatment items fr cancer cases with specific tumr characteristics. Missing/Incmplete Tumr Characteristics (site/type/stage) Missing/Incmplete Site-Specific Factrs (prgnstic factrs) Missing/Incmplete First Curse Treatment Clinical Checks are based n cnsensus measures fr quality f cancer care develped by CC and NPCR fr specified cancers. Endrsed by Natinal Quality Frum, CC, ASCO, and NCCN. If the reprted treatment des nt appear t be cnsistent with widely recgnized standards f care r cases fail t cntain knwn prgnstic characteristics, a warning is generated. 2
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NPCR AUDIT INCLUDED CLINICAL CHECKS NPCR Clinical Check Edits 2010 Data Ttal Eligible Cases Ttal Cases With Warning Messages Ttal Cases Withut Warning Messages Percentage f Cases Withut Warning Messages Prgnstic and Staging Inf, Breast (Clin2) Prgnstic and Staging Inf, Cln (Clin2) Radiatin With Breast-Cnserving Surg (Clin2) Radiatin With Rectal Cancer Surgery (Clin2) Surgically Treated Nn-metastatic Cln Canc (Clin2) Systemic Treatment With Breast Surgery (Clin2) 3,646 1,323 2,323 63.71% 960 590 370 38.54% 1,326 614 712 53.70% 115 115 0 0.00% 520 209 311 59.81% 1,048 621 427 40.74% Any discrepancy generated warning that standard treatment nt captured r recrded. 4
Clinical Edit Checks 2010 Cnslidated Data % f Cases Withut Warnings Prgnstic and Staging Inf, Breast 64% Prgnstic and Staging Inf, Cln 39% Radiatin With Breast-Cnserving Surgery 54% Radiatin With Rectal Cancer Surgery 0% Surgically Treated Nn-metastatic Cln Cancer 60% Systemic Treatment With Breast Surgery 41% 0% 20% 40% 60% 80% 100%
TIMELINE FOR CLINICAL EDIT CHECKS CC-apprved Cancer Prgrams have already instituted similar checks with CP3R yu are ahead f the curve NPCR still unsure when CDC plans t begin requiring them NPCR is already using them in audits/evaluatins as indicatr FCDS may intrduce trial Clinical Checks fr pilt test facilities S, these are n ur radar but nt yet required by NPCR/FCDS 6
Clinical Edit Check Examples - Breast
CLINICAL EDIT CHECK EXAMPLE #1 Prgnstic and Staging Inf, Breast The purpse f this particular clinical check is t ascertain that staging and prgnstic infrmatin is cmplete fr breast cases eligible fr the Clinical Checks. Selectin Criteria: Primary Site = C500-C506, C508-C509 Sex = 2 Histlgic Type ICD-O-3 = 8000-8576,8940-8950,8980-8981,9020 Behavir Cde ICD-O-3 = 3 Age at Diagnsis 018-120 CS Mets at DX = 00 RX Summ--Surgery Prim Site = 20-90 8
CLINICAL EDIT CHECK EXAMPLE #1 Data Items used fr this Clinical Edit Check: Sex CS Lymph Ndes Eval Date f Diagnsis CS Mets at DX Age at Diagnsis CS Site-Specific Factr 1 Primary Site CS Site-Specific Factr 2 Histlgic Type ICD-O-3 CS Site-Specific Factr 9 Behavir Cde ICD-O-3 CS Site-Specific Factr11 CS Tumr Size CS Site-Specific Factr13 Reginal Ndes Examined CS Site-Specific Factr14 Reginal Ndes Psitive RX Summ--Surg Prim Site RX Summ Scpe Reg LN Sur 9
CLINICAL EDIT CHECK EXAMPLE #1 If any f the staging r prgnstic items is blank r unknwn (r nt dne), a WARNING is given t check fr the infrmatin. If CS Lymph Ndes Eval is 3-8 where Scpe f Reginal Lymph Nde Surgery is 0 (n reginal lymph ndes remved) and/r the Number f Reginal Lymph Ndes Examined is 00 (n ndes examined), a WARNING is given. Fr CS Lymph Ndes Eval f 3-8, reginal lymph ndes must have been micrscpically assessed. HER2 Test Interpretatin Fields (SSF 9, 11, 13, r 14) at least ne f the fur data items must nt be blank, 988, r 999 10
CLINICAL EDIT CHECK EXAMPLE #2 Radiatin With Breast-Cnserving Surgery The purpse f this particular clinical check is t ascertain that radiatin is given within ne year (365 days) f diagnsis and fully recrded fr nn-metastatic breast cancer treated with breast-cnserving surgery. Selectin Criteria: Primary Site = C500-C506, C508-C509 Sex = 2 Histlgic Type ICD-O-3 = 8000-8576,8940-8950,8980-8981,9020 Behavir Cde ICD-O-3 = 3 Age at Diagnsis 018-069 CS Mets at DX = 00 RX Summ--Surgery Prim Site = 20-24 11
CLINICAL EDIT CHECK EXAMPLE #2 Data Items used fr this Clinical Edit Check: Sex Date f Diagnsis Age at Diagnsis Primary Site Histlgic Type ICD-O-3 Behavir Cde ICD-O-3 CS Mets at DX RX Summ--Surg Prim Site Reasn fr N Radiatin Rad Reginal RX Mdality RX Date Radiatin RX Date Radiatin Flag RX Summ Surg/Rad Seq 12
CLINICAL EDIT CHECK EXAMPLE #2 If the Reasn fr N Radiatin is 2 r 5 (cntraindicated r patient died), n further editing is perfrmed by this edit. If the Reasn fr N Radiatin is 6 (planned, unknwn why nt given) r 8 (planned, unknwn if given), r RX Date--Radiatin Flag = 15 (planned), a WARNING is given: "Fllw this patient carefully fr recmmended radiatin." If the Reasn fr N Radiatin is 9 (unknwn whether radiatin recmmended r administered), a WARNING is given: "Patients fitting this prfile shuld usually receive radiatin - please check." 13
CLINICAL EDIT CHECK EXAMPLE #2 Fr all ther cases fitting the prfile, a check fr cmpletely cded radiatin fllws. Warnings are given under the fllwing cnditins: If Rad--Reginal RX Mdality is 00 (n radiatin) r 99 (unknwn) r blank - WARNING: "What is the Radiatin Mdality? Please check. If RX Date--Radiatin Flag is 10 (unknwn if radiatin administered), 11 (n radiatin administered) r 12 (radiatin administered, but date unknwn) - WARNING: "Please check fr the date Radiatin Therapy began. If RX Summ--Surg/Rad Seq is 0 (n radiatin and/r surgery, r unknwn if surgery and/r radiatin given) r 9 (sequence unknwn, but bth surgery and radiatin given) r blank - WARNING: "What is the Radiatin/Surgery Sequence? Please check." 14
CLINICAL EDIT CHECK EXAMPLE #2 Fr patients fitting the prfile, RX Date--Radiatin must n later than 365 days after Date f Diagnsis. If later than 365 days, a WARNING is given: "Patients fitting this prfile nrmally receive radiatin within 365 days." 15
CLINICAL EDIT CHECK EXAMPLE #3 Systemic Treatment With Breast Surgery The purpse f this particular clinical check is t verify that chemtherapy is fully cded fr patients with nn-metastatic large r nde-psitive, ER- and PR- resected breast cancer and that it is given within 120 days f diagnsis. This edit als verifies that hrmne therapy is fully cded fr these patients if ER and/r PR is psitive r brderline and that it is given within 365 days f diagnsis. 16
CLINICAL EDIT CHECK EXAMPLE #3 Selectin Criteria: Primary Site = C500-C506, C508-C509 Sex = 2 Histlgic Type ICD-O-3 = 8000-8576,8940-8950,8980-8981,9020 Behavir Cde ICD-O-3 = 3 Age at Diagnsis 018-120 CS Tumr Size = 011-989 CS Lymph Ndes = 130-800 CS Mets at DX = 00 CS Site Specific Factr 1 (Estrgen Receptr Assay) = 010-030 CS Site Specific Factr 2 (Prgesterne Receptr Assay) = 010-030 RX Summ--Surgery Prim Site = 20-90 17
CLINICAL EDIT CHECK EXAMPLE #3 Data Items Used in This Clinical Edit Check: Sex CS Lymph Ndes RX Summ Chem Date f Diagnsis CS Lymph Ndes Eval RX Date Chem Age at Diagnsis CS Mets at DX RX Date Chem Flag Primary Site CS Site-Specific Factr 1 RX Summ Hrmne Histlgic Type ICD-O-3 CS Site-Specific Factr 2 RX Date Hrmne Behavir Cde ICD-O-3 RX Summ--Surg Prim Site RX Date Hrmne Flag CS Tumr Size RX Summ Scpe Reg LN Sur RX Summ Systemic/Sug Seq Reginal Ndes Examined RX Date Systemic Flag Reginal Ndes Psitive 18
CLINICAL EDIT CHECK EXAMPLE #3 Only fr Ages 018-069: If CS Site Specific Factr 1 and CS Site Specific Factr 2 = 020 (negative/nrmal) r 030 (brderline): If RX Summ--Chem = 82, 85, r 87 (cntraindicated, patient died, r treatment refused), the case passes the edit, and n further editing dne. If RX Summ--Chem = 86 (planned, unknwn why nt given) r 88 (planned, nt yet started), a WARNING is given: Fllw this patient carefully fr recmmended chemtherapy., and n further editing dne. If RX Summ--Chem nt = 03 (chem, multiple agents), a WARNING is given: Patients with this prfile usually receive cmbinatin chemtherapy. Please check. If RX Date--Chem Flag = 10 (unknwn if chemtherapy administered), 11 (n chemtherapy administered), r 12 (chemtherapy administered but date is unknwn), a WARNING is given: Please check fr the date chem began RX Date--Chem must be n later than 120 days after Date f Diagnsis. 19
CLINICAL EDIT CHECK EXAMPLE #3 Ages 018-120: If CS Site Specific Factr 1 and/r CS Site Specific Factr 2 = 010 (psitive) r 030 (brderline): If RX Summ Hrmne = 82, 85, r 87 (cntraindicated, patient died, r treatment refused), the case passes the edit, and n further editing dne. If RX Summ Hrmne = 86 (planned, unknwn why nt given) r 88 (planned, nt yet started), a WARNING is given: Fllw this patient carefully fr recmmended hrmne tx., and n further editing dne. If RX Summ Hrmne nt = 01 (hrmne tx administered), a WARNING is given: Patients with this prfile usually receive hrmne therapy. Please check. If RX Date Hrmne Flag = 10 (unknwn if hrmne tx administered), 11 (n hrmne tx administered), r 12 (hrmne tx administered but date is unknwn), a WARNING is given: Please check fr date hrmne began. RX Date Hrmne must be n later than 365 days after Date f Diagnsis. 20
CLINICAL EDIT CHECK EXAMPLE #3 Ages 018-120: If RX Summ Chem is nt 82, 85, 86, 87, r RX Summ Hrmne is nt 82, 85, 86, 87, r 88: If RX Date Systemic Flag = 10 (unknwn if systemic therapy administered), 11 (n systemic therapy administered), r 12 (systemic therapy administered but date is unknwn), a WARNING is given: Please check fr date systemic therapy began. If RX Summ-Systemic/Sur Seq = 0 (n systemic therapy and/r surgery) r 9 (sequence unknwn) r blank, a WARNING is given: What is the SystemicSurgery Sequence? 21
FCDS EFFORTS TO IMPROVE RESULTS Educate Flrida Registrars n where t find key SSF data Educate Flrida Registrars n hw t cde key SSF fields Add key SSFs t DQI Reprt when missing, unknwn, nt dne Cmplete lp back t CC-apprved Cancer Prgrams frm medical nclgy practice reprting prgram nce fully n-line Wrk with natinal partners t enhance Clinical Edit Checks 22
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