Treatment Capture from Follow Back to Oncology Offices by Frances Ross Presented at the 2013 NAACCR Annual Conference Austin, TX

Background KCR began Hospital reporting in 1991 and Non-hospital reporting in 1995 KCR requires KY hospitals to report ALL first course therapy on their patients Non-hospital facilities send lists, twice a year (spring and fall), of patients seen in the first (or second) half of the previous year.

Reporting Timeline Hospital cases diagnosed from Jan-June 2011 are reported to KCR from July-Dec _________________________________________________ Jan 2011 June July Dec

Reporting Timeline Hospital cases diagnosed from Jan-June 2011 are reported to KCR from July-Dec _________________________________________________ Jan 2011 June July Dec __________NHF cases seen Jan-Jun are requested_____________________________ Jan 2012 June July Dec

Reports sent from NHFs

Resulting in two file sets MATCHED CASES NONMATCHED CASES

Non-matched cases Reviewed by KCR staff for reportability Staff access NHF source records (manually or electronically) Staff complete full abstract on these cases NONMATCHED CASES

Matched cases MATCHED CASES Are currently ignored because: Already reported by a hospital Treatment is required to be reported by hospital Central registry staff resources are limited

What if we could review Matches? Purpose of this study: To evaluate and quantify the amount of additional treatment information that could be obtained if KCR staff followed back and reviewed source records on oncologists’ patients who matched records already in KCR.

To recap: Reports to KCR from NHFs result in two files NON-MATCHES MATCHES Oncology practices Oncology clinics lists Large multispecialty clinics Pathology laboratories Urologists Dermatologists These were abstracted by KCR staff

Included in Study Non-Matches Matches - included 14 Oncology practices and oncology clinics These were abstracted by KCR staff These are not part of this study. Matches excluded from study: Urologists, dermatologists, Pathology Labs, 3 clinics (technical problems)

Methods Obtained matched patient lists from 5 radiation oncology facilities, 6 medical oncology practices, and 3 multi-specialty clinics with both radiation and medical oncology Reviewed matched patient with central record to be sure cancer case matched as well Reviewed therapy recorded in central registry to identify potentially missing treatments ◦Used NCCN guidelines ◦Reviewed abstract text for any explanatory comments

CASES MATCHED IN CENTRAL & REVIEWED CASES WITH SUSPECTED MISSED TX FACILITY ID BOTH BOTH BOTH MED ONC MED ONC2 299 MED ONC MED ONC MED ONC MED ONC RAD ONC RAD ONC RAD ONC RAD ONC RAD ONC TOTAL Methods

Methods After reviewing central record, KCR staff accessed the oncologists’ records either manually or electronically, by on site visits or by remote Internet connection Staff recorded any additional treatment documented in physician records, as well as any other information relevant to a cancer abstract

CASES MATCHED IN CENTRAL & REVIEWED CASES WITH SUSPECTED MISSED TX NUMBER OF CASES W/MISSED 1ST COURSE TX FACILITY ID BOTH BOTH BOTH MED ONC MED ONC MED ONC MED ONC MED ONC MED ONC RAD ONC RAD ONC RAD ONC RAD ONC RAD ONC TOTAL Results

CASES MATCHED IN CENTRAL & REVIEWED CASES WITH SUSPECTED MISSED TX NUMBER OF CASES W/MISSED 1ST COURSE TX % CASES w/ MISSED TX FOUND TOTAL MISSED 1st CRS TREATMENTS FACILITY ID BOTH %24 BOTH %22 BOTH %301 MED ONC %14 MED ONC %3 MED ONC %48 MED ONC %142 MED ONC %17 MED ONC %14 RAD ONC %2 RAD ONC %11 RAD ONC %72 RAD ONC %17 RAD ONC %29 TOTAL %716 Results

823 Cases – Before review

823 Cases – After review

Other information found Type of additional informationCount Subsequent treatments235 Reasons for no therapy52 Dates of death75 Site code errors17 Missed cases found20 Correct SSN/Name18 Case not a reportable cancer2 Histology errors3

Study costs Initial review of patient lists hours Actual review of source records hours Travel time - 30 hours 293 hours Travel expenses - $700.00

Discussion Valuable information may be obtained from physician office records There is a cost/time burden for data collection from these source records…either to the hospitals, the physicians, or the central registry staff Electronic data submissions from physicians’ EHR systems through the KHIE may represent the best opportunity to obtain these data efficiently and cost effectively