2. Croatian CRC screening registry data base and indicators
izv.prof.dr.sc. Nataša Antoljak

3. Croatian CRC screening registry-obstacles
no legal existance, no obligation of using it
no legal foundation that this is part of e-documentation
no finantial support even for regular maintain
expectations were that all job will be finished in one year and no connection to other parts of health e-system was noticed by decission makers
who is responsible body?-currently it is ministry of health who is holder of program)
continous need for upgrade of current aplication is obvious
aplication and data are situated on server of Croatian health inssurance institute
population database and legal foundation is not defined

4. … obstacles
problem of too much data entering CEZIH (Central electronic health information system)
we expect all participants know and write in data forms
problem of partial duplication of filling data (hospital info system and primary care)
lack of coordination with other parts in health information system
old or no IT equipement, slow PC, too musch time losed for people working with it
too much IT knowledge needed for people which primary education is health care!
nobody belive who is not actively working in this system-frustration, new obstacles

5. Croatian CRC screening registry-advantages
using primary data
quality of data affects quality accurance!
comunication with all proffesionals involved in program
followup of patient till finnal diagnose (staging of developed disease maybe needed-but we expect it would be captured from onko-message)
ability to get predefined reports and own analyse (we need more education about this to interested coleagues)
these analyses must be dominant job of MD epidemiologists/public health practitioners, not administration
necesser and unaivodalbe in quality control and followup of quality improvement

6. eligible population M and F, 50-74 yrs.
Letter-invitation for testing, broshure,
addressed envelop for answer to local public health institute
returned with information of noncompliance (according to postman mark or by coordinator, or by invited person, or family member): dead, temporary absent, unknown address
returned answer, signed informed conset that like testing
correctly placed specimens on all 3 cards and filled questionaire
person already have crc or done testing in las 1 year or colonosopy in last 2 years
non-compliance-reporting
NEGATIVE- invitation after 2-3 years in next cycle
POZITIVE-invitation to colonoscopy+Rp Moviprep+instructions bowel cl.
INFORMATION to primary care physician
POZITIVE- Cancer-phd and final diagnose at colonoscopy unit
NOT TO BE INVITED IN NEXT CYCLE! (STILL NOT APPLICABLE DUE TO NOT COMPLETED ONE CYCLE WITH 100% DATA)
THERAPY, TREATMENT
POZITIVE, POLYP-POLIPECTOMY at same, eventually next colonoscopy (regular procedure), waiting for phd and final diagnose at colonoscopy unit
INVITED ACCORDING TO GUIDELINES! (STILL NOT APPLICABLE)
POZITIVE, OTHER DISEASES OF COLON OR RECTUM-instructions for management at colonoscopy unit
NEGATIVE- INVITATION IN NEXT CYCLE AFTER 5 YEARS
consultation and additional advices at primary care physician
additional exams and staging of disease
no response or dislike testing, second invitation, PCP, patronage
within 6 weeks
OUT OF PROGRAME
Primary care physicyans, patronage nurses-informing eligible population before and during invitations
send envelop with 3 card tests, prescription, questionary, pvc sealed package-patient returne specimens to institute
returned empty questionaire or incorrectly placed specimens or cards without specimen-about 3% (in most cases tel. number and name of PCP, about 1/3 of them never send specimen)
County public health institute team database Croatian institute of health inssurance
second invitation-Public health institute
Colonosopy complications reporting

7. Indicators target population (M+F 50-74) invited
responded to invitation letter
total returned FOB tests
returned FOB tests with correctly aplied specimens
positive (and relative to tested)
invited to colonoscopy
performed colonoscopy
performed total colonocopy
persons with confirmed diagnose (ca, polyp, advanced adenoma, other lessions)
quality indicators of colonoscopy and patohistology readings

23. printing address block

26. Colonoscopic and phd part…

27. Reports

29. Target population Invited Responders to invitaiton (or test) Tested
RESPONSE 0= the number of persons invited from target population/responses, the call (regardless of whether they want to be tested, have some reason for non-response or do not want to test)
RESPONSE 1= tested/invited
RESPONSE 2= number tested + processed for bowel disease + tested in the last year+colonoscopied
invited-died- already have cancer-temporarily unavailable-incorrect address
Target population
Invited
Responders to invitaiton (or test)
Tested
Died during the invitation cycle/already have CRC/another disease of colorectum/do not like/emigrated or temporary out of RH
Formula depend if we removed persons at the begining of cycle because these persons sholud not be invited