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

2. 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.

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

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

5. Reports sent from NHFs

6. Resulting in two file sets MATCHED CASES NONMATCHED CASES

7. 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

8. 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

9. 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.

10. 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

11. 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)

12. 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

13. CASES MATCHED IN CENTRAL & REVIEWED CASES WITH SUSPECTED MISSED TX FACILITY ID BOTH1 3724 BOTH2 6628 BOTH3 685263 MED ONC1 10439 MED ONC2 299 MED ONC3 39796 MED ONC4 281167 MED ONC5 8030 MED ONC6 5621 RAD ONC1 1056 RAD ONC2 6514 RAD ONC3 12170 RAD ONC4 4616 RAD ONC5 9340 TOTAL 2165823 Methods

14. 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

15. CASES MATCHED IN CENTRAL & REVIEWED CASES WITH SUSPECTED MISSED TX NUMBER OF CASES W/MISSED 1ST COURSE TX FACILITY ID BOTH1 372417 BOTH2 662814 BOTH3 685263190 MED ONC1 1043911 MED ONC2 2992 MED ONC3 3979634 MED ONC4 281167106 MED ONC5 803016 MED ONC6 562111 RAD ONC1 10562 RAD ONC2 65149 RAD ONC3 1217056 RAD ONC4 461611 RAD ONC5 934026 TOTAL 2165823505 Results

16. 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 BOTH1 37241745.9%24 BOTH2 66281421.2%22 BOTH3 68526319027.7%301 MED ONC1 104391110.6%14 MED ONC2 29926.9%3 MED ONC3 39796348.6%48 MED ONC4 28116710637.7%142 MED ONC5 80301620.0%17 MED ONC6 56211119.6%14 RAD ONC1 105621.9%2 RAD ONC2 6514913.8%11 RAD ONC3 121705646.3%72 RAD ONC4 46161123.9%17 RAD ONC5 93402628.0%29 TOTAL 216582350523.3%716 Results

18. 823 Cases – Before review

19. 823 Cases – After review

20. 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

21. Study costs Initial review of patient lists - 120 hours Actual review of source records - 143 hours Travel time - 30 hours 293 hours Travel expenses - $700.00

22. 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