California Cancer Registry 2012 Casefinding Audit in Freestanding Radiation Treatment Centers CCR Project ID #300.72 Final Report Prepared by: Kyle L. Ziegler, CTR The Data Standards and Quality Control Unit (DSQC) of the California Cancer Registry (CCR) performed a casefinding audit of a freestanding radiation treatment center in early 2012. The CCR DSQC staff worked with the Data Collection Unit (DCU) staff to identify facilities in Southern California that met the criteria of a freestanding radiation treatment facility. The casefinding and abstracting for this facility is performed by the DCU. Background The CCR selected a radiation oncology group that operates facilities in multiple regions in the state. Oncure Radiation Oncology operates 35 radiation oncology centers in 3 states, with 16 of these facilities located in California. The 16 facilities are located in five separate regions, three of which are Southern California regions. For this audit, the CCR selected one facility located in Region 10. The CCR obtained the required documents through working with the radiation oncology groups’ home office. This was extremely helpful and reduced the amount of time spent on the upfront preparation of the audit. The casefinding audit required a review of radiation therapy reports for all patients seen in 2010. The facility saw over 900 patients during the year, with approximately 500 new cancer cases. In accordance with the California Code of Regulations, title 17, section 2593, facilities diagnosing or treating more than 100 cancer cases a year are considered a cancer reporting facility and they are required to report these cases. The staff at Oncure Radiation Oncology corporate offices provided a report in the form of a spreadsheet that included several data items that were requested. Among these data items were: the patient’s social security number, patient’s first and last name, the patient’s zip code, diagnostic code, date of first service or encounter, type of treatment, and the procedure code or the CPT code. The spreadsheets were divided between two auditors, Cheryl Moody and Marianne Schlecht. Each patient listed on the spreadsheet was checked against the Eureka database. Patients who were found in the Eureka database were considered matched and the quality of the treatment data in the Eureka database was compared to the information on the spreadsheet. Patients who were not found in the Eureka database were considered missed cases. All missed cases were then moved to the reconciliation process. The reconciliation was performed by the DCU since they perform the casefinding and abstracting functions for the facility. Current Case Processing Methodology for this Reporting Facility The Data Collection Unit performs casefinding and abstracting for this Oncure facility for a fee. Oncure sends the DCU a spreadsheet once a year. Data Collection Unit staff reviews each case on the spreadsheet to see if each case is in the Eureka data base. If the case is found in the Eureka database, it is checked for radiation treatment information. If there is no radiation associated with the case, the DCU staff enters the radiation information into the consolidated case. A new case admission is not created in Eureka. If the case has not been reported, a new case admission is created in Eureka. May 2, 2012 1 California Cancer Registry 2012 Casefinding Audit in Freestanding Radiation Treatment Centers CCR Project ID #300.72 Final Report Prepared by: Kyle L. Ziegler, CTR This reporting facility sees more than 500 new cases a year. This is a significant work effort for the DCU staff to perform from a single reporting facility. Audit Findings A total of 593 cases were reviewed. Of the 593 reviewed cases, there were 550 cases matched in the Eureka data base and a total of 43 (7.8%) missed cases, which results in a completeness rate of 92.2%. Breast and prostate cases were missed most often with nine cases (20.9%) each. Cases with an unknown primary site had four missed cases (9.3%). Lung, parotid gland, and tongue each had two missed cases (4.7%). The distribution of all missed cases is documented in Table 1. Since the CCR was provided with specific treatment information, the auditor was able to determine two data quality elements: 1) Treatment completeness 2) Accuracy of the reported treatment codes The spreadsheet included Current Procedural Terminology (CPT) codes. The CPT codes were used to determine the type of radiation treatment the patient received. The CPT codes have equivalent codes in Volume I, and each CPT code was evaluated and compared to the reported code in the Eureka data base. In most cases, a higher code was entered in the treatment fields in the Eureka database. In evaluating treatment completeness, the audit revealed that of the 550 matched cases on the Eureka database, 266 cases (83.1%) had no radiation treatment reported. The spreadsheets indicated a specific type of radiation was administered to the patient during the first course of treatment. This information may not have been available to another reporting facility submitting the case to the CCR. This information is important to accurately and completely document the patient’s treatment. There were an additional 54 cases (16.9%) in which the spreadsheet identified a more accurate treatment code than what was reported. This is documented in Graph 1. An example of more accurate treatment information is the reported radiation treatment modality code was 20 (Radiation, NOS) and the treatment summary documents Intensity Modulated Radiation Treatment (IMRT), which should have been reported as radiation treatment modality code 31. There were seven cases in which there was no social security number in the CCR data base however; while performing the audit, a social security number was discovered from the radiation treatment facility documents. The Eureka data base was updated with this new information. May 2, 2012 2 California Cancer Registry 2012 Casefinding Audit in Freestanding Radiation Treatment Centers CCR Project ID #300.72 Final Report Prepared by: Kyle L. Ziegler, CTR Project Cost, Benefit and Core Team The projected number of hours expected for this project was 350. The number of actual hours spent preparing and conducting this audit is approximately 205 hours. The core team consisted of Cheryl Moody, CTR, Marianne Schlecht, CTR, and Kyle L. Ziegler, CTR. Conclusion Out of the 593 cases reviewed, 550 cases were matched in the Eureka database and 43 (11.8%) cases were missed. There were 266 (83.1%) cases in which there was no radiation therapy treatment information in Eureka. There was more accurate radiation therapy treatment information available in 54 (16.9%) cases. Many cases in this audit did not have radiation therapy treatment information coded. This is due to increasing and backlogged workloads for the Data Collection Unit. Entering this treatment information into Eureka has been considered low priority. Additionally, there were seven cases in which the CCR was able to collect social security numbers on patients that were in the Eureka database with an unknown social security number. Recommendations With shrinking budgets and increased workloads, the DCU should consider hiring a contractor to report these cases for this facility or suggest that Oncure hire another contractor directly. This would reduce the work load for the DCU. The practice of entering the radiation treatment into the consolidated record should be evaluated. This information is unverifiable information in the Eureka system, meaning there is no admission information associated with the case. These cases are considered Class of Case 20 cases and are reportable in accordance with the California Code of Regulations, title 17, section 2593. Since it is not routine practice to enter treatment information from Class 20 cases from any other reporting sources, freestanding radiation facilities should be no exception. May 2, 2012 3 California Cancer Registry 2012 Casefinding Audit in Freestanding Radiation Treatment Centers CCR Project ID #300.72 Final Report Prepared by: Kyle L. Ziegler, CTR Distribution of Missed Cases by Primary Site Primary Site Number Missed Breast Prostate 9 9 Unknown Primary 4 Lung Parotid Gland 2 2 Tongue 2 Adrenal Gland Bone 1 1 Brain 1 Cheek Mucosa Esophagus Glottis 1 1 1 Hodgkins Lymphoma Lip-Vermillion Nasopharynx 1 1 1 Non-Hodgkins Lymphoma Pancreas Rectosigmoid Colon 1 1 1 Rectum Tonsil 1 1 Trachea 1 N= 43 May 2, 2012 4 California Cancer Registry 2012 Casefinding Audit in Freestanding Radiation Treatment Centers CCR Project ID #300.72 Final Report Prepared by: Kyle L. Ziegler, CTR Radiation Therapy Treatment Completeness N = 320 More Specific Radiation Treatment Available; 17% (N = 54) No Radiation Treatment Recorded; 83% (N = 266) May 2, 2012 5