www.champsods.com Making the Most of Your Cancer Registry Presenter: Toni Hare, Vice President CHAMPS Oncology Data Services Picture of girl here December 11, 2009
Learning Objectives Upon completion of the presentation, the participant will be able to: Distinguish how registry data is applied to decisions affecting future planning Develop steps to better utilize registry data for quality improvement studies & outcomes Understand the registrar s role in meeting accreditation standards
The Evolution of Cancer Registry Data in Cancer Control Current: Quality Care Measures & Improvement Strategies Past Present Future Traditional: Data Reporting Future Trends: Information for Financial Incentives, Regulation and Policy
Who utilizes cancer registry data? Healthcare Institutions Evaluate clinical care of cancer patient. Plan, monitor & evaluate programs & services. National Organizations [Commission on Cancer (CoC), American Cancer Society (ACS)] Explore trends in cancer care. Create regional and state benchmarks for participating hospitals. Serve as the basis for quality improvement. Government & Federal Agencies [Surveillance Epidemiology and End Results (SEER), National Cancer Institute (NCI), Center for Disease Control (CDC)] Collect and analyze cancer incidence for a specific population or geographic area. Measures progress in cancer prevention & control.
Cancer Registry: First Source of Information Cancer Programs utilize cancer registry data to: Enhance Oncology Service Offerings Develop Administrative & Marketing Plans Determine costs associated with staffing needs, resource allocation, ancillary services utilization Evaluate performance measures & outcomes Meet Accreditation Standards Slide 23
Criteria for a Lung Scorecard Quality Measure Definition Rationale for Measuring Target Data Source Collection Frequency Responsibility Notification of diagnosed patients New inpatients and outpatients contacted by patient navigator Patient access to support svcs. 60% Path Reports Monthly Patient Navigator/ Cancer Registry Lymph node dissection # of lobectomy & pneumonectomy patients with LN dissection Accurate Staging, prognosis & Tx decisions 80% Path / OP Report Quarterly Cancer Registry Cancer Staging Number of Cases staged accurately Physician staging accuracy 95% Registry Physician QA Audit Monthly Cancer Registry Time to Tx for SCLC Start date = date of confirmed diagnosis and stage End date = date of initial Tx Patient satisfaction & patient survival Less than or equal to 14 days Treatment Letters Quarterly Cancer Registry EBUS Patients # of patients staged using EBUS Utilization of the procedure TBD OP Report Quarterly Cancer Registry
Lung Cancer Scorecard Metrics QUALITY MEASURE Target Dec-07 Jan-08 Feb-08 Mar-08 Apr-08 May-08 Jun-08 Jul-08 Aug-08 Sep-08 Oct-08 Nov-08 Lymph node dissection (%) 80% 100% 100% 100% 78% 71% 75% 100% 100% 100% 100% 100% 100% Utilization of Distress Scale (OP Rad Onc) 90% 50% 75% 86% Documention of patient education (OP Rad Onc) 90% 100% 100% 100% Nurse navigator contact (IP) 60% 35% 53% 43% 59% 50% 65% 82% 50% 44% Nurse navigator contact (OP) 60% 14% 59% 19% 33% 42% 43% 50% 14% 62% Cancer staging 95% 45% 50% 40% 80% 89% Time to treatment for SCLC patients < 14 days 100% 80% 100% 100% 100% 50% 100% 88% 80% 100% 100% 100% EBUS cases count 9 13 7 17 12 7 15 9 18 Mediastinoscopy cases count 5 1 5 5 6 3 4 6 2 Inpatient surgery cases count 10 7 2 11 7 14 8 5 6 11
Marketing
Link cancer registry data with financial data to: Estimate revenue by disease site Recruit physicians Identify staffing needs Analyze costs & utilization of ancillary services
Utilization of Ancillary Services Number of visits per patient by stage Medical Admissions All I II III IV 2.2 1.2 1.8 2.1 2.9 Radiation Therapy All I II III IV 16.6 2.3 16.3 19.7 22.0 Inpatient Surgery All I II III IV 1.6 1.0 1.1 1.5 2.7 Radiology All I II III IV 14.3 14.5 18.1 13.7 14.4 Outpatient Surgery All I II III IV 2.9 1.7 1.2 3.3 6.9 New Lung Cancer Cases Laboratory All I II III IV 28.6 25.1 27.6 27.8 43.1 Source: Oncology Roundtable, Oncology revenue Strategy
Cancer Registry Resource Justification Annual revenue per cancer site 100% 90% 80% 70% 60% 50% 40% $109,655 $45,135 $70,680 $346,620 Annual revenue of 20 newly diagnosed cases/year: $346,620 30% 20% 10% 0% $120,950 Annual direct expense of 5.5 FTE cancer registry department: 5 Lung Cases 5 Prostate Cases 5 Breast Cases 5 Colon Cases $345,807 Source: Commission on Cancer (CoC): Measuring the Quality of Your Cancer Care, 2006
Quality Improvement Activities Establish the study topic & define the measures Collect information Plan Do Act Check Take action to improve patient care and monitor actions Evaluation of Quantitative Report How does your registry connect to the quality process in your facility?
Registry Study improves clinical care Study Topic: (patients identified from cancer registry) Improve wait time from radiation consult to initial treatment for prostate cancer patients Analysis: (data captured in cancer registry database) Dx date, Consult date, Date Radiation Tx Started Outcome: (quantitative report provided by cancer registry) Average wait time 165 days Action: Purchased & installed IMRT Additional 1 hour added to RT Clinic schedule Monitor the effectiveness of action plan implemented Improvement- 29 days
Registry study results improved patient care Study Topic: (patients identified from cancer registry) Improve wait time from mammogram to biopsy Analysis: (data captured in cancer registry & radiology department) Avg of Abnormal Mam to Diag Mam, Avg of Diag Mam to Bx Started Outcome: (quantitative report provided by cancer registry) Average wait time 24-28 days for each diagnostic process Action: Hire a Breast Health Navigator Open a women's health center Monitor the effectiveness of action plan implemented (cancer registry) Improvement- Reduced wait time to 19 days
Industry Standard Setters The National Accreditation Program for Breast Centers represents a consortium of national, professional organizations dedicated to the improvement of the quality of care and monitoring of outcomes of patients with diseases of the breast. The Commission on Cancer (CoC) is a consortium of professional organizations dedicated to improving survival and quality of life for cancer patients through standardsetting, prevention, research, education, and the monitoring of comprehensive quality care
Revised CoC Standard 4.3 Stage & Treatment Planning Cancer committee (or other leadership body) develops a process to monitor physician use of AJCC or other appropriate staging site-specific prognostic indicators evidence based national treatment guidelines Findings are presented at least annually and documented in the minutes
Intent of New CoC Standard 4.3 Create a process to promote the delivery of high quality evaluation and treatment for the cancer patient Capture the concurrent data that is required to document the quality of cancer patient evaluation and treatment within a cancer program
CoC Standard 4.3 Evaluation Components Physician Clinical Stage Completion & Accuracy Site-Specific Prognostic Indicators Appropriate treatment choices based on site specific factors/indicators Treatment planned/performed Compliance of the treatment plan to national guideline selected
Registrar s Role in CoC Standard 4.3 Identify cases for review Track results of staging accuracy Tabulate the appropriateness of treatment plan based on stage & prognostic indicators Tabulate treatment plan adherence to each aspect of national guideline Quantitative & Qualitative Results reported to Cancer Committee
Example Analysis of CoC Standard 4.3
Utilizing Registry Data for National Accreditation Program for Breast Centers Topic Study Criteria for NAPBC Accreditation Action Breast Conservation Identify lumpectomy vs. mastectomy Utilize cancer registry Sentinel Node Biopsy Identify number of sentinel lymph nodes removed Create a special field Breast Cancer Staging Collect the site specific prognostic indicators for breast cancer, identify cases to be reviewed, tabulate results and present to cancer committee Create special field for prognostic indicators Needle Biopsy Record initial diagnostic approach for needle biopsies Create a special field
Utilizing Cancer Registry Data for National Quality Forum Measures CoC and NAPBC s Breast Cancer measures endorsed by NQF Radiation therapy administered within 1 year of Dx for women under age 70 receiving BCS Combination chemotherapy considered or administered within 4 mos of dx for women under age 70 with AJCC T1c, Stage II or III hormone receptor negative Tamoxifen or third generation aromatase inhibitor is considered for women with AJCC T1c, Stage II or III hormone receptor positive
Utilizing Cancer Registry Data for NQF Measures CoC s Colon Cancer measures endorsed by NQF Adjuvant chemo is considered or administered within four months of Dx for patients under age 80 with AJCC Stage III At least 12 lymph nodes are removed and pathologically examined for resected colon cancer
Utilizing Cancer Registry Data for CoC/ASCO/NCCN Measures CoC s Rectal Cancer Measure endorsed by ASCO/NCCN Radiation therapy is considered or administered within 6 months of Dx for patients under the age of 80 withi clinical or pathologic AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer
Anywhere Hospital, United States Performance Rate Comparison Anywhere Hospital, United States
Contact Information Toni Hare, RHIT, CTR, Commission on Cancer-trained Independent Consultant Vice President, CHAMPS Oncology Data Services 216.255.3716 toni.hare@chanet.org