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NPCR/CDCDATA QUALITY
EVALUATION AUDIT
Claudia Cooksie, CTR,RHIT
Quality Assurance and Training Coordinator
OSCaR Fall Educational Workshop
October 9, 2015
NPCR/CDC
• Develop and enhance statewide cancer registries• Operate registries effectively• Develop model legislation• Establish a computerized reporting and data processing
system • Monitor the completeness, timeliness and quality of data
Oregon State Cancer Registry
DIAGNOSIS YEAR: 2012
Centers for Disease Control and Prevention Department of Health and Human Services
CDC Contract No. 200200827960
Data Quality Evaluation AuditConfidentiality and Security
• All evaluation functions performed under state Confidentiality Statues
• DQE staff signed confidentiality agreements• Only De-identified case files sent• Data used only for evaluation purposes• Data destroyed according to the DQE assurance of
destruction
Data Quality Evaluation AuditPurpose
• Consistency – Interpretation and abstracting
• Identify problems – Data collection and interpretation
• Assess quality of data– Text Documentation– Data Consolidation– Completeness of treatment information
Data Quality Evaluation AuditCriteria for Selection of Cases
• Number of cases: 200 cases• Diagnosis year: Diagnosis year 2012 • State of Residence: Oregon residents only• ICD-O-3 Behavior Code: 2 or 3• Primary Sites:
– Female Breast (C500-C509)– Colon (C180-C189,C26.0)– Rectosigmoid Junction (C199)– Rectum (C209)– Lung (C340-C349)– Prostate (C619)– Corpus Uteri (C540-C549 and C55.9)
Data Quality Evaluation Audit OSCaR Prepared 2 Extract Files
• First File- “Master Extract File”– Consolidated Record (OSCaR)
• Second File-Extract File– Source level documents (raw data files) from
reporting sources
Data Quality Evaluation AuditVisual Editing Evaluation Process
• Visual Editing evaluation sample – Included 413 cases abstract-level cases
• All data elements and corresponding text were reviewed for each abstract-level case
• Any abstract-level codes not substantiated by text were recoded by the evaluators
• The recoded fields were used for the re-consolidation process
Data Quality Evaluation AuditReconsolidation Process
• Each abstract-level data element was compared to the corresponding data elements – In the OSCaR “consolidated record”
• Reconsolidation was conducted – Customized CRS Plus Utility
• Data were imported into – MS Access and discrepant data elements were displayed
• Data were provided to OSCaR – Addressed during the reconciliation process
Data Quality Evaluation AuditReconciliation Process
• Database with reconsolidated cases with the visual editing changes were provided to OSCaR
• OSCaR reviewed cases and provided explanations when they disagreed with the evaluators recode
• Evaluators reviewed responses and reversed any recoded data elements resolved by OSCaR
Number of Data Elements and Cases Reviewed by Site
Site
Number of DataElementsReviewed
Number ofCases Reviewed
Colon 336 14Rectum 432 18Lung 800 32Female Breast 2,673 81Corpus Uteri 400 16Prostate 975 39Total 5,616 200
Site
Number of DataElementsReviewed
Number ofCases Reviewed
Percentage ofCases Reviewed
Breast 31 40 20%
Colon 31 39 20%
Corpus Uteri 31 20 10%
Lung 31 40 20%
Prostate 31 30 15%
Rectosigmoid Junction 30 10 5%
Rectum 30 20 10%
Total 215 199
Central Cancer RegistryNPCR Treatment Data Edits
• Purpose– Evaluate reported prognostic and treatment items
for cancer cases with specific tumor characteristics
– 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
NPCR Treatment Data ChecksExamples
• Radiation with Breast-Conserving Surgery– Checks that radiation is given within one year (365 days) of diagnosis
and fully recorded for non-metastatic breast cancer treated with breast-conserving surgery
• Surgical Treated Non-metastatic Colon Cancer– First-checks that at least 12 lymph nodes are examined in surgically
resected colon cases. Then, for node-positive patients, checks whether chemotherapy is given within 4 months (120 days) of diagnosis and fully recorded
• Radiation with Rectal Cancer Surgery– Reviews whether radiation is given within 6 months (180 days) of
diagnosis and fully recorded for selected non-metastatic rectal cancer surgical patients
Data Quality Evaluation AuditData Items
• Text vs Coded Values• 21 Basic items in the abstract• 30 Treatment data elements• Completeness of treatment
– NPCR “Treatment Data Checks”• Breast• Colon• Rectum
Data Quality Evaluation AuditData Elements-Basic
• Primary site– Subsite
• Laterality• Histology/Behavior• Grade• Date of Diagnosis• Sequence Number-Central
Data Quality Evaluation AuditData Elements-Collaborative Stage
• CS Tumor Size• CS Extension• CS Tumor Size Ext/Eval• Regional Nodes Positive• Regional Nodes Examined• CS Lymph Nodes• CS Metastasis at Diagnosis• Derived SS2000
Data Quality Evaluation Audit Data Elements-SSF’s• CS SSF 1- (Breast) Estrogen Receptor (ER) Assay• CS SSF 2- Progesterone Receptor (PR) Assay• CS SSF 3- Number of + ipsilateral Level I-II axillary LN• CS SSF 8- HER2: IHC Lab Value• CS SSF 9- HER2: IHC Test Interpretation• CS SSF 10- HER2: FISH Lab Value• CS SSF 11- HER2: FISH Test Interpretation• CS SSF 12- HER2: CISH Lab Value• CS SSF 13- HER2: CISH Test Interpretation• CS SSF 14- HER2: Result of Other or unknown test
• CS SSF 2- (Corpus Uteri) Peritoneal Cytology• CS SSF 3- (Prostate) Pathologic Extension• CS SSF 1- (Lung)-Separate tumor nodules-Ipsilateral lung
Data Quality Evaluation AuditData Elements-Treatment data• Date of 1st course RX-CoC• Date of Surgery Primary Site• RX Summary Surgery Primary Site• RX Summary Scope Regional Lymph Node Surgery• Summary Surgery other Regional/Distant• RX Date Radiation• Radiation Regional RX Modality• RX Summ Radiation and Surgery Sequence• RX Date Chemotherapy• RX Date Hormone• RX Date Biological Response Modifier• RX Date Summary Transplant/Endocrine• RX Date Other• RX Summary Other
Graphical Results for Data Accuracy
Frequency of Errors by Primary Site
8
8
10
29
11
17 BreastColonCorpus UteriLungProstateRectosigmoid JunctionRectum
Total = 74 Major Errors
Frequency of Major Errors across All Sites
8
7
6
6
6
65
3
3
3
3
18
GradeRX Summ—Scope Reg LN SurCS Site-Specific Factor 1Derived SS2000Date of 1st Crs RX--CoCRX Date – SurgeryRX Date—ChemoCS ExtensionRX Date—RadiationRX Summ—Surg/Rad SeqRX Date—HormoneOther
Percent of Error-Free Cases by Data Element by Primary Site
Gra
de
RX Sum
m—
Scope
Reg
LN S
ur
Derive
d SS20
00
Date
of 1
st C
rs R
X--CoC
RX Dat
e –
Surge
ry
RX Dat
e—Che
mo
CS Exte
nsion
RX Dat
e—Rad
iation
RX Sum
m—
Surg/
Rad S
eq
RX Dat
e—Hor
mon
e85.00%
90.00%
95.00%
100.00% 97.50% 97.50%
100.00% 100.00%
97.50%
100.00% 100.00%
97.50%
100.00%
92.50%
Breast
Percent of Error-Free Cases by Data Element by Primary Site
Grade
RX Sum
m—
Scope
Reg
LN S
ur
Derive
d SS20
00
Date
of 1
st C
rs R
X--CoC
RX Dat
e –
Surge
ry
RX Dat
e—Che
mo
CS Ext
ensio
n
RX Dat
e—Rad
iatio
n
RX Sum
m—
Surg/
Rad S
eq
RX Dat
e—Hor
mon
e75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
ColonRectosigmoidRectum
Percent of Error-Free Cases by Data Element by Primary Site
Grade
RX Sum
m—
Scope
Reg
LN S
ur
CS Site
-Spe
cific
Facto
r 1
Derive
d SS20
00
Date
of 1
st C
rs R
X--CoC
RX Dat
e –
Surge
ry
RX Dat
e—Che
mo
CS Ext
ensio
n
RX Dat
e—Rad
iatio
n
RX Sum
m—
Surg/
Rad S
eq
RX Dat
e—Hor
mon
e75.00%
80.00%
85.00%
90.00%
95.00%
100.00%
LungProstateCorpus Uteri
Accuracy RateConsolidated Data Elements
Data Accuracy (%)=
100 subtract
(100* Number of Data Elements with Discrepancies Divided by Total Number of Data Elements)
Accuracy Rate for OSCaR = 98.8%
100 - (74/6139) * 100= 98.8%
Abstracting PracticesText vs Code
• Text documentation is required for all coded data elements
• This is the process by which the central registry must validate each abstract submitted.
• Example- 65 yr old white female-– justifies age, sex and race in only a few words!
Abstracting PracticesText vs Code-Grade
• Missed coding specific grade – Text specifically stated the grade
• Review coding guidelines for grading– “low” or “high” grade tumors
• If a lesion is both invasive and in-situ– Code grade for only the invasive portion
• Do not record FIGO grade as histologic grade – FIGO is a three-tier system and does not convert into a
four-tier grading system• Code grade from the Primary site only
– Not from a lymph node or metastatic site
Abstracting PracticesDate of First Course of Treatment• FORDS Manual indicates “For invasive cancers of the
uterus, dilation and curettage is coded as an incisional biopsy (02) under the data item Surgical Diagnostic and Staging Procedure”– This is not considered surgical treatment and should not be
coded as first course of treatment
• Original dates were found to be blank when the text indicated patients either received chemotherapy, had lymph node biopsies, or the decision not to treat was documented– The FORDS Manual states “If a physician decides not to treat a
patient, the date of first course of treatment is the date this decision was made”
Abstracting Practices- Primary Site-BreastDate of First Surgical Procedure
• Review the FORDS rules for recording the “Date of First Surgical Procedure of Primary site”• Surgery of Primary Site• Scope of Regional Lymph Node Surgery• Surgical Procedure/Other Site
• If any of these procedures are performed, the Date of Surgery should be the EARLIEST date of any of these procedures occurred• Example: In Breast, if an axillary lymph node biopsy is performed prior
to definitive surgery (after the initial biopsy), the date of the axillary lymph node biopsy becomes the date of the first surgical procedure and recorded in the “Scope of lymph node surgery” field and the date of first course treatment field.
Abstracting PracticesRegional Nodes Pos/Examined
• Regional Lymph Nodes Positive and Regional Lymph Nodes examined were switched between the two data items– 00/98 when should be 98/00
• Run/Pass Edits
Abstracting PracticesRegional Nodes Pos/Examined
• Question- If AJCC lists a lymph node as Regional and Summary Stage lists the lymph node as Distant, how do we code Regional Lymph Nodes Positive and Regional lymph nodes examined?– This question was answered on September 3, 2015 NAACCR
Webinar on “Coding Pitfalls”– FORDS Manual in “Scope of Regional LN Surgery” section-
“Refer to the current AJCC Cancer Staging Manual for site-specific identification of regional lymph nodes”
• Answer- When there is a difference between the two standard setters on regional lymph nodes, defer to AJCC
Abstracting Practices- Primary Site-BreastScope of LN surgery-Example
• A patient with a breast primary has a fine needle aspiration (FNA) of an axillary lymph node. The FNA would be coded as:– A) Diagnostic Staging Procedure– B) Surgical Procedure Primary Site– C) Scope of Regional Lymph node surgery– D) Surgical Procedure/Other Site
• Patient with a breast primary undergoes an excisional biopsy of a cervical lymph node, the excisional biopsy would be coded as:– A) Diagnostic Staging Procedure– B) Surgical Procedure Primary Site– C) Scope of Regional Lymph node surgery– D) Surgical Procedure/Other Site
Abstracting Practices- Primary Site-BreastSite Specific Factors
• Site Specific Factors 8-9 and 10-14– Her2 values and Interpretation
• IHC• FISH • CISH
Abstracting Practices-Primary Site-BreastCollaborative Stage Tumor Size/Ext Eval
• Clinical CS Tumor size – Preoperative adjuvant treatment
• Incorrect CS Ext/Eval codes– Preoperative adjuvant treatment
• CS LN codes – Use more specific codes
Abstracting Practices-Primary Site-BreastSurgery Primary Site Coding
• Coded as “50” (Modified Radical Mastectomy)– Use more inclusive code of:
• Without removal of uninvolved contralateral breast (51-56)
• With removal of uninvolved contralateral breast (52-63)
Abstracting Practices-Primary Site-BreastGrade
• Record the highest grade of tumor regardless of specimen size– Grade used in resection was lower than the grade in the
biopsy• Use the highest grade regardless of specimen size
– if the lesion is both invasive and in situ code • Grade only from the invasive component (FORDS)
Abstracting Practices-Primary Site-ColonMiscellaneous
• Code CS Tumor Size from Primary site not from a metastatic site
• Partial resection liver due to metastases is considered “Surgery Procedure/Other Site” – FORDS describes as “surgical removal of distant lymph node(s) or other
tissue(s) or organ(s) beyond the primary site”
• If chemotherapy is recommended, but unknown if administered or the treatment was delayed with no further information, use code “88”
Abstracting Practices-Primary Site-ColonSurgery/Radiation Sequence
• If the patient undergoes an exploratory laparotomy and the decision that no additional surgery would be recommended, impacts Surgery/Radiation sequence– The exploratory lap is not considered surgery of the
primary site. If no surgery was performed, then sequence of surgery/radiation would equal zero.
Abstracting Practices-Primary Site-ColonMiscellaneous edits
• CS Extension– Subserosal fat invasion confused with pericolic fat invasion
• Changes Stage (Localized vs Regional Dir Ext)
• Surgery Primary Site– Coding a partial colectomy (30) when it should be
hemicolectomy (40)
• Surgery Primary Site and Date First Course Treatment– If polypectomy is done with negative margins and then followed
by a part Colectomy, date of first course should be polypectomy
• Missed coding specific grade – Text indicated Moderately or Poorly Differentiated
Abstracting Practices-RectoSigmoid JunctionPrimary site Code
• An illustrated reference for mapping the colon, Rectosigmoid and Rectum by centimeters may be helpful to insure accurate coding – When the pathology report describes the mass as 6cm from the
anus or if the mass is located 6-8cm from the dentate line. The rectum occupies the space between 4-16 cm from the anus.
Training Resources• http://en.wikipedia.org/wiki/List_of_medical_abbreviations• http://seer.cancer.gov/tools/codingmanuals/index.html• http://seer.cancer.gov/seerinquiry/index.php• http://www.facs.org/cancer/coc/fordsmanualolder.html• http://afritz.org/freetools/index.htm• http://cancerbulletin.facs.org/forums/forum.php• http://apps.who.int/classifications/apps/icd/icd10online/• http://www.findacode.com/• http://www.cdc.gov/Cancer/npcr/tools/registryplus/rpoh_tech_info.htm• http://home.comcast.net/~wnor/• http://www.cancer.gov/• http://www.nccn.org/index.asp• https://cancerstaging.org/cstage/schema/Pages/version0205.aspx• http://www.cap.org/apps/cap.portal?_nfpb=true&cntvwrPtlt_actionOverride=
%2Fportlets%2FcontentViewer%2Fshow&_windowLabel=cntvwrPtlt&cntvwrPtlt%7BactionForm.contentReference%7D=committees%2Fcancer%2Fcancer_protocols%2Fprotocols_index.html&_state=maximized&_pageLabel=cntvwr
OSCaR and Registrars
