NPCR CLINICAL EDIT CHECKS

FCDS Annual Meeting

July 26, 2013

Sunrise, Florida

Steven Peace, CTR

FCDS Data Quality Staff

PURPOSE OF CLINICAL EDIT CHECKS

o The primary purpose of the Clinical Check edits is to evaluate reported prognostic and treatment items for cancer cases with specific tumor characteristics. o Missing/Incomplete Tumor Characteristics (site/type/stage)

o Missing/Incomplete Site-Specific Factors (prognostic factors)

o Missing/Incomplete First Course Treatment

o Clinical Checks are based on consensus measures for quality of cancer care developed by CoC and NPCR for specified cancers.

o Endorsed by National Quality Forum, CoC, ASCO, and NCCN.

o If the reported treatment does not appear to be consistent with widely recognized standards of care or cases fail to contain known prognostic characteristics, a warning is generated.

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PLUS

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NPCR AUDIT INCLUDED CLINICAL CHECKS

NPCR Clinical Check Edits—2010 Data

Total

Eligible

Cases

Total

Cases With

Warning

Messages

Total

Cases

Without

Warning

Messages

Percentage

of Cases

Without

Warning

Messages

Prognostic and Staging Info, Breast (Clin2) 3,646 1,323 2,323 63.71%

Prognostic and Staging Info, Colon (Clin2) 960 590 370 38.54%

Radiation With Breast-Conserving Surg (Clin2) 1,326 614 712 53.70%

Radiation With Rectal Cancer Surgery (Clin2) 115 115 0 0.00%

Surgically Treated Non-metastatic Colon Canc (Clin2) 520 209 311 59.81%

Systemic Treatment With Breast Surgery (Clin2) 1,048 621 427 40.74%

Any discrepancy generated warning that standard treatment not captured or recorded.

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Clinical Edit Checks

2010 Consolidated Data

% of Cases Without Warnings

Systemic Treatment With Breast Surgery

Surgically Treated Non-metastatic Colon Cancer

Radiation With Rectal Cancer Surgery

Radiation With Breast-Conserving Surgery

Prognostic and Staging Info, Colon

Prognostic and Staging Info, Breast

0% 20% 40% 60% 80% 100%

64%

39%

54%

0%

60%

41%

TIMELINE FOR CLINICAL EDIT CHECKS

o CoC-approved Cancer Programs have already instituted similar

checks with CP3R – you are ahead of the curve

o NPCR still unsure when CDC plans to begin requiring them

o NPCR is already using them in audits/evaluations as indicator

o FCDS may introduce trial Clinical Checks for pilot test facilities

o So, these are on our radar but not yet required by NPCR/FCDS

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Clinical Edit Check Examples - Breast

CLINICAL EDIT CHECK – EXAMPLE #1

Prognostic and Staging Info, Breast

The purpose of this particular clinical check is to ascertain that

staging and prognostic information is complete for breast cases

eligible for the Clinical Checks.

Selection Criteria:

Primary Site = C500-C506, C508-C509

Sex = 2

Histologic Type ICD-O-3 = 8000-8576,8940-8950,8980-8981,9020

Behavior Code ICD-O-3 = 3

Age at Diagnosis 018-120

CS Mets at DX = 00

RX Summ--Surgery Prim Site = 20-90

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CLINICAL EDIT CHECK – EXAMPLE #1

Data Items used for this Clinical Edit Check:

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Sex CS Lymph Nodes Eval

Date of Diagnosis CS Mets at DX

Age at Diagnosis CS Site-Specific Factor 1

Primary Site CS Site-Specific Factor 2

Histologic Type ICD-O-3 CS Site-Specific Factor 9

Behavior Code ICD-O-3 CS Site-Specific Factor11

CS Tumor Size CS Site-Specific Factor13

Regional Nodes Examined CS Site-Specific Factor14

Regional Nodes Positive RX Summ--Surg Prim Site

RX Summ – Scope Reg LN Sur

CLINICAL EDIT CHECK – EXAMPLE #1

If any of the staging or prognostic items is blank or unknown (or not done), a WARNING is given to check for the information.

If CS Lymph Nodes Eval is 3-8 where Scope of Regional Lymph Node Surgery is 0 (no regional lymph nodes removed) and/or the Number of Regional Lymph Nodes Examined is 00 (no nodes examined), a WARNING is given.

For CS Lymph Nodes Eval of 3-8, regional lymph nodes must have been microscopically assessed.

HER2 Test Interpretation Fields (SSF 9, 11, 13, or 14) – at least one of the four data items must not be blank, 988, or 999

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CLINICAL EDIT CHECK – EXAMPLE #2

Radiation With Breast-Conserving Surgery

The purpose of this particular clinical check is to ascertain that

radiation is given within one year (365 days) of diagnosis and

fully recorded for non-metastatic breast cancer treated with

breast-conserving surgery.

Selection Criteria:

Primary Site = C500-C506, C508-C509

Sex = 2

Histologic Type ICD-O-3 = 8000-8576,8940-8950,8980-8981,9020

Behavior Code ICD-O-3 = 3

Age at Diagnosis 018-069

CS Mets at DX = 00

RX Summ--Surgery Prim Site = 20-24

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CLINICAL EDIT CHECK – EXAMPLE #2

Data Items used for this Clinical Edit Check:

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Sex RX Summ--Surg Prim Site

Date of Diagnosis Reason for No Radiation

Age at Diagnosis Rad – Regional RX Modality

Primary Site RX Date – Radiation

Histologic Type ICD-O-3 RX Date – Radiation Flag

Behavior Code ICD-O-3 RX Summ – Surg/Rad Seq

CS Mets at DX

CLINICAL EDIT CHECK – EXAMPLE #2

If the Reason for No Radiation is 2 or 5 (contraindicated or

patient died), no further editing is performed by this edit.

If the Reason for No Radiation is 6 (planned, unknown why not

given) or 8 (planned, unknown if given), or RX Date--Radiation

Flag = 15 (planned), a WARNING is given: "Follow this patient

carefully for recommended radiation."

If the Reason for No Radiation is 9 (unknown whether radiation

recommended or administered), a WARNING is given: "Patients

fitting this profile should usually receive radiation - please

check."

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CLINICAL EDIT CHECK – EXAMPLE #2

For all other cases fitting the profile, a check for completely coded radiation follows. Warnings are given under the following conditions:

If Rad--Regional RX Modality is 00 (no radiation) or 99 (unknown) or blank - WARNING: "What is the Radiation Modality? Please check.“

If RX Date--Radiation Flag is 10 (unknown if radiation administered), 11 (no radiation administered) or 12 (radiation administered, but date unknown) - WARNING: "Please check for the date Radiation Therapy began.“

If RX Summ--Surg/Rad Seq is 0 (no radiation and/or surgery, or unknown if surgery and/or radiation given) or 9 (sequence unknown, but both surgery and radiation given) or blank - WARNING: "What is the Radiation/Surgery Sequence? Please check."

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CLINICAL EDIT CHECK – EXAMPLE #2

For patients fitting the profile, RX Date--Radiation must no later

than 365 days after Date of Diagnosis.

If later than 365 days, a WARNING is given: "Patients fitting this

profile normally receive radiation within 365 days."

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CLINICAL EDIT CHECK – EXAMPLE #3

Systemic Treatment With Breast Surgery

The purpose of this particular clinical check is to verify that

chemotherapy is fully coded for patients with non-metastatic

large or node-positive, ER- and PR- resected breast cancer and

that it is given within 120 days of diagnosis.

This edit also verifies that hormone therapy is fully coded for

these patients if ER and/or PR is positive or borderline and that

it is given within 365 days of diagnosis.

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CLINICAL EDIT CHECK – EXAMPLE #3

Selection Criteria:

Primary Site = C500-C506, C508-C509

Sex = 2

Histologic Type ICD-O-3 = 8000-8576,8940-8950,8980-8981,9020

Behavior Code ICD-O-3 = 3

Age at Diagnosis 018-120

CS Tumor Size = 011-989

CS Lymph Nodes = 130-800

CS Mets at DX = 00

CS Site Specific Factor 1 (Estrogen Receptor Assay) = 010-030

CS Site Specific Factor 2 (Progesterone Receptor Assay) = 010-030

RX Summ--Surgery Prim Site = 20-90

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CLINICAL EDIT CHECK – EXAMPLE #3

Data Items Used in This Clinical Edit Check:

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Sex CS Lymph Nodes RX Summ – Chemo

Date of Diagnosis CS Lymph Nodes Eval RX Date – Chemo

Age at Diagnosis CS Mets at DX RX Date – Chemo Flag

Primary Site CS Site-Specific Factor 1 RX Summ – Hormone

Histologic Type ICD-O-3 CS Site-Specific Factor 2 RX Date – Hormone

Behavior Code ICD-O-3 RX Summ--Surg Prim Site RX Date – Hormone Flag

CS Tumor Size RX Summ – Scope Reg LN Sur RX Summ – Systemic/Sug Seq

Regional Nodes Examined RX Date Systemic Flag

Regional Nodes Positive

CLINICAL EDIT CHECK – EXAMPLE #3

Only for Ages 018-069: If CS Site Specific Factor 1 and CS Site Specific Factor 2 = 020 (negative/normal) or 030 (borderline):

If RX Summ--Chemo = 82, 85, or 87 (contraindicated, patient died, or treatment refused), the case passes the edit, and no further editing done.

If RX Summ--Chemo = 86 (planned, unknown why not given) or 88 (planned, not yet started), a WARNING is given: “Follow this patient carefully for recommended chemotherapy.”, and no further editing done.

If RX Summ--Chemo not = 03 (chemo, multiple agents), a WARNING is given: “Patients with this profile usually receive combination chemotherapy. Please check.”

If RX Date--Chemo Flag = 10 (unknown if chemotherapy administered), 11 (no chemotherapy administered), or 12 (chemotherapy administered but date is unknown), a WARNING is given: “Please check for the date chemo began”

RX Date--Chemo must be no later than 120 days after Date of Diagnosis.

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CLINICAL EDIT CHECK – EXAMPLE #3

Ages 018-120: If CS Site Specific Factor 1 and/or CS Site Specific Factor 2 = 010 (positive) or 030 (borderline):

If RX Summ—Hormone = 82, 85, or 87 (contraindicated, patient died, or treatment refused), the case passes the edit, and no further editing done.

If RX Summ—Hormone = 86 (planned, unknown why not given) or 88 (planned, not yet started), a WARNING is given: “Follow this patient carefully for recommended hormone tx.”, and no further editing done.

If RX Summ—Hormone not = 01 (hormone tx administered), a WARNING is given: “Patients with this profile usually receive hormone therapy. Please check.”

If RX Date—Hormone Flag = 10 (unknown if hormone tx administered), 11 (no hormone tx administered), or 12 (hormone tx administered but date is unknown), a WARNING is given: “Please check for date hormone began.”

RX Date—Hormone must be no later than 365 days after Date of Diagnosis.

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CLINICAL EDIT CHECK – EXAMPLE #3

Ages 018-120: If RX Summ–Chemo is not 82, 85, 86, 87,

or RX Summ–Hormone is not 82, 85, 86, 87, or 88:

If RX Date—Systemic Flag = 10 (unknown if systemic therapy

administered), 11 (no systemic therapy administered), or 12

(systemic therapy administered but date is unknown), a WARNING

is given: “Please check for date systemic therapy began.”

If RX Summ-Systemic/Sur Seq = 0 (no systemic therapy and/or

surgery) or 9 (sequence unknown) or blank, a WARNING is given:

“What is the SystemicSurgery Sequence?”

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FCDS EFFORTS TO IMPROVE RESULTS

Educate Florida Registrars on where to find key SSF data

Educate Florida Registrars on how to code key SSF fields

Add key SSFs to DQI Report when missing, unknown, not done

Complete loop back to CoC-approved Cancer Programs from

medical oncology practice reporting program once fully on-line

Work with national partners to enhance Clinical Edit Checks

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QUESTIONS

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