Cancer Registry Follow-up How we do it Hank Neloms & Tonya Clark Anne Arundel Medical Center March 15, 2013

Agenda Cancer Follow-up Confidentiality Standards Exclusions Timing Preparation The Process Follow-up Letters Lost to Follow-Up CRISP Questions

Cancer Follow-up The objectives of Follow-up are: To determine outcomes of treatment To determine the patient’s current vital status Collect information on any recurrence including treatment and any new primary cancer.

Confidentiality Confidentiality must be maintained when obtaining patient follow-up Cancer Registries must have policies and procedures approved by the cancer committee that includes both a written and verbal contacting compliance with Federal law, State law, and hospital policy. Our hospital policy is to contact only the patient’s physicians and the patient themselves. We do not make a practice of contacting the patients relatives or loved ones.

Standards Cancer Registries are required to fulfill the following CoC standards: Standard 5.3: 80% follow-up rate for all eligible analytic patients from the registry reference date. Standard 5.4: 90% follow-up rate for all eligible analytic patients diagnosed within the last five years.

Exclusions Non-analytic cases, reportable by agreement, class of case 0 (diagnosed after 1/10/2006), All patients over the age of 100 years old Carcinoma in-situ of the cervix Benign and borderline histologies In-situ and localized basal and squamous cell carcinomas of the skin Foreign residents

Preparation All registries generate mailing lists of patient who will soon become lost to follow-up (No contact after 15 months). This process of researching patients should begin at 12 months from their last date of contact and continue until they become lost to follow-up after 15 months. A mailing list should be prepared consisting of patients that range from 12 months after their most recent date of contact to 15 months after the most recent date of contact. Before these letters are printed and mailed, this list should be checked against your hospital’s database to see if any patients have been treated at your facility. Once the list has been audited and the patient’s contact status has been updated, the mailing list should be run again. All updated patients will not show up on the new mailing list.

The Process Once the mailing list has been researched, letters can be mailed out using the “FMRP” method. All patients who have not been updated in 12 months should have a follow-up letter sent to their following physician (F). All patients who have not been updated in 13 months should have a follow-up letter sent to their managing physician (M) All patient s who have not been updated in 14 months should have a follow-up letter sent to their referring physician (R) All patients who have not been updated in 15 months should have a follow-up letter sent to the patient himself (P)

Follow-up Letters Patient Letter Recovery Status Attending MD Info Address Confirmation Physician Date of Last Contact Recurrence

Obituaries Obituaries should be checked once a week to capture any of your patients who have expired.

Lost to Follow-up Patients are considered delinquent /Lost to Follow-up when there is no record of their health status after 15 months. Names of patients who are lost to follow-up (delinquent) should remain in the follow-up system until follow-up is obtained This lost to follow-list should be audited periodically to determine that all lost to follow-up remain in the system and are continually pursued for current follow-up.

Timing – How we do it Weekly Monthly Twice yearly Obituaries are checked Monthly Patients on mailing list is audited against hospital database. Patient and physician letters mailed out Twice yearly Lost to Follow up list from the reference date audited

Chesapeake Regional Information System CRISP – A Follow-up Resource Chesapeake Regional Information System ()

Registration Access CRISP portal: http://hie.crisphealth.org/ Register for the CRISP training webinar session Submit User Request Following the webinar submit photo ID to complete application process Once confirmation email is received you may use the provided password to access CRISP for treatment purposes only.

CRISP A Follow-up Resource Access CRISP Portal. Log onto CRISP website. Click Continue to website. You have entered the patients virtual health record. Click patient lookup. Enter patient’s demographics: Last Name, First Name and Date of Birth then click search.

CRISP – A Follow-up Resource When your query returns a result, click the radial button to “Accept Usage Terms and Conditions” Click continue You now have access to outside encounters for that patient Choose a link that may be useful in your quest for follow-up data Repeat the process to query other patients.

Questions?