Using Collaborative Staging Data In Reports Authored By Ted Williamson, MD, PhD, CTR Teresa Mason, RHIT, CTR and Dianne Cleveland, RHIA, CTR

Part One: Collaborative Staging CS Task Force was organized in 1998 Develop a translation between TNM and SEER Eliminate duplicate data collection by registrars Address the concerns of clinicians for more clinically relevant data Deal with data reproducibility over time Improve compatibility between SEER and NCDB and expand data-sharing opportunities

CS Data Input Involves Just 13 Fields, but, 9 Site-Specific Fields………

And 94 Different Sites, resulting in 1316 Coding Tables

The CS Innovation: Standardized Calculation of Stage You enter data into the 13 fields. Your registry program passes this data plus histology, behavior, grade, age to a program developed at CDC. The CDC program runs edits. If no errors are found, computes derived AJCC TNM and SEER staging. The CDC program passes results back to your registry software system.

CS Data Is Returned in Two Formats Storage codes – sent in NAACCR & NCDB records. Software must store them but may not display them. Display strings - physician and registrar friendly. T S

CS - In Summary CS is surprisingly functional in spite of its complexity. Benefits are CS long-term, particularly in stage-based comparative studies of treatment and outcomes. Automated translation of data to summary codes along with edits that identify CS coding errors help maintain error free data. CS is not saving abstracting time!

Part Two: Exploring Ways To Use CS Data How to extract the CS data from your software system in various forms such as spreadsheets, using tools such as MS Excel. You got it in, now let’s see how to get it out!

Proposed Project: Staging Quality Assessment Question: How does physician TNM staging compare to CS TNM derived staging? How do we present this? Suggested Data Fields: –Basic diagnostic fields –Physician TNM & CS TNM Derived Staging –Any other pertinent standard or custom user-defined data fields

Good Points to Remember (before getting started) Make the spreadsheet format and content as general as possible. You may want to use it over and over again. We suggest you export as a TAB delimited text file. This will give you important flexibility when you bring the data back into Excel. Include column headers. If you can, export staging data in the NAACCR reporting format (1A, 3B, etc.) rather than the classic form (T1A, SIIIB, …) or the CS storage code (29, 30, 31, 32, …). Much easier to work with.

If Your Excel Toolbar Looks Like This… You’re not ready to go to work yet.

Essential Excel Tool Buttons for Registry Data Operations

14 Excel Buttons Essential to Registry Work

Using Excel Import Wizard

Remove Unneeded Columns

The Result May Need Some Clean Up Some cases have no data. Many cases have one or both stages marked as 99 or unknown. For some cases staging is not applicable (88). Derived stage is in the “classic” AJCC format. “A” and “B” subgroups would be difficult to deal with quantitatively.

Fortunately – Excel Has Tools Right click on the corner box. The entire worksheet is highlighted.

Autofilters Click on the “Autofilter” icon. Click on the arrow by the cS column header. A list of all encountered values appears. Click on “88.”

This Is a Cool Tool! You have filtered out all but the rows with a clinical stage group of “88”. Click on first cell, second row and drag down to the last row with data. Click on the “delete rows” icon.

What Happened to My Data? Click again on the autofilter arrow in column B. The 88’s are missing from the occurrence table. Click on (All).

Nothing Lost! The data re-appears, without rows containing ’88’. Repeat the process for the 99’s, blanks and other data you can’t use in your study. As the occurrence table shows, this column is clean. Now do the same for CS Derived Stage.

Two Problems Remain For the report we need simple Arabic numbers for comparison. Derived stage is in Roman numerals. Both staging systems have suffix A’s, B’s, etc.

Tidy up the Romans First Click on the column label cell – the column is highlighted. Click Edit on the menu bar. Click Replace on the menu. Enter “IV” in Find what and “4” in Replace with: Click Replace All. Repeat the process for III, II, and I

Get Rid of The Suffixes Click in D2 and enter the formula “=LEFT(B2,1)”. This captures the first character in cell B2 and places it in D2. Now, click on D2, put your cursor on the little square in the lower right corner and drag down to fill all the rows.

Repeat in Column E Copy D2 to E2 (the formula is copied and updated for cell position). Copy the contents of E2 down the column. Mission accomplished!

Doing the Math Click in F2 and enter the formula “=D2-E2” Click again in F2 and drag on the corner, down the column. The result is a table of differences between physician TNM stage and CS derived stage.

Label and Mark Put a label in F1 Click in the middle of F1 and drag down to the bottom row with data.

Launch Pivot Table Click on the Pivot Table button. Click Next on Wizard Step 1. Click Next on Wizard Step 2. Click Finish on Wizard Step 3. Excel is really smart.

Drag Drag column title to “Drop Row Fields Here”. Drag column title to “Drop Data Items Here.

Almost There! Excel calculated a numeric sum for each score. Click on the Pivot Table Field button. Change Summarize by to “Count” and click OK.

That’s Better Now the “Total” represents the number of cases with each score. To present the data in a graph format, click on the graph button.

The First Cut – You Will Need To Tune It Up Right Click in the “Count” Box Select Hide…

After Using Some Standard Excel Chart Formatting Tools…

With These Basic Principles, Many Questions Can Be Answered With CS Data How does ER status correlate to hormone use in breast cancer patients. What is the average number of lymph nodes resected in Stage III colorectal cancer? How often are colorectal cases upstaged by surgery? Which doctor does the best staging? Which sites are most successfully staged?

More QA Opportunities Some Ideas: Use custom fields to code deviations such as physician TNM vs Derived.

Quality Assurance Opportunities Identify data discrepancies Determine why there are discrepancies (physician education, registry staff training, etc) Develop a plan to resolve the issue Implement the plan Measure the results

Comparing SEER Summary 2000 to Derived SEER Consider looking at differences in SEER Summary Staging and Derived SEER.

Using Collaborative Staging Data In Reports Start using your CS data. You got it in, now you know how to get it out.