The Commission on Cancer: Reengineering the National Cancer

Data BaseStephen B. Edge MD FACS

Chair Commission on CancerAmerican College of Surgeons

Alfiero Chair of Breast OncologyProfessor of Surgery and Oncology

Roswell Park Cancer InstituteUniversity at Buffalo

“The Commission on Cancer is a consortium of professional organizations dedicated to reducing the morbidity and mortality of cancer through education, standard setting, and the monitoring of quality of care.”

Commission on CancerMission Statement

CoC Programs

• Accreditation (formerly Approval)

• Physician Liaison

• Education

• Quality– National Cancer Data Base

80% of Cancer in US Treated in CoC Accredited Programs

Treatedelsewhere

20%

Diagnosed and treated in approved programs

80%

Hospitals without

approved programs

75%

Hospitals with

approvedprograms

25%

General medical/surgical facilitiesIncluding Puerto Rico=~5000General medical/surgical facilitiesIncluding Puerto Rico=~5000

CoC Accredited Programs:Primarily Community-Based

37

35

17

24

2 2

COMPCHCPTHCPVACPNCIPNCPOther

CommunityComprehensive

Community

Teaching

New Directions for the Accreditation Program

• Complete revision of standards underway

• Quality Focus

• Performance - Based

• CoC Accreditation Program only national community-based program that has full loop of standards, data collection, and feedback

National Cancer Data Base• Aggregation of the cancer registry data

from CoC accredited programs

• Objectives– Surveillance of cancer incidence– Evaluation of patterns of care– Active quality management

• CP3R; E-QuIP• Future - Rapid Quality Reporting System

(RQRS)

Cumulative Cases Reported to NCDBby Diagnosis Year

Millions Cases 85 - 03

0

5

10

15

20

'85 '86 '87 '88 '89 '90 '91 '92 '93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03

Since 1995, the National Cancer Data Base has captured over 22 million cancer cases

National Cancer Data Base –Quality Tools

• NCDB Hospital Comparison Benchmark Reports

• NCDB Survival Report

• Cancer Program Practice Profile Reports (CP3R v.2)

• Rapid Quality Reporting System

CoC Survival Reports

Registry Activities to ModernizeRegistry Activities to Modernize

•• Rapid case ascertainment for quality Rapid case ascertainment for quality measurementmeasurement–– Rapid case acquisitionRapid case acquisition–– New quality measures based on guidelinesNew quality measures based on guidelines

•• Supplementation with administrative dataSupplementation with administrative data

–– Payer claimsPayer claims–– Hospital dataHospital data–– Electronic Health RecordElectronic Health Record

NCDB:Applying Quality Measures

• NCDBUsed to establish quality measure– NQF– Harmonized with ASCO-NCCN measures

• Application in NCDB– For all CoC accredited programs– Data provided to programs– Increasing level of use and required action

Quality Measures and the Quality Measures and the Commission on CancerCommission on Cancer

•• CoC Approvals Program provides a unique CoC Approvals Program provides a unique national system for application of quality national system for application of quality measuresmeasures

–– Data collection structureData collection structure–– Centralized data storage and analysisCentralized data storage and analysis–– Existing structure for feedback and reporting to Existing structure for feedback and reporting to

providersproviders–– Existing program of public reportingExisting program of public reporting

Feedback Tools of the NCDB

20042004 CPCP33R R Chemotherapy with Stage III Colon Chemotherapy with Stage III Colon CancerCancer

2006 2006 Electronic Quality Improvement Electronic Quality Improvement Program (eQuIP)Program (eQuIP)

2009: 2009: Enhanced Enhanced CPCP33RR

2010:2010: Rapid Quality Reporting SystemRapid Quality Reporting System

CP3R: 2004• Data Reconciliation• Periodic Rate Adjustment• Facility Specific Data• Comparison Data

e-QuIP: 2006• Data Reconciliation• Immediate Rate Adjustment• Facility Specific Data

CP3R (v2) -2009

Case review and on-line reconciliation:Just like e-QuIP

Comparisons:Just like CP3R

Rapid Quality Reporting System:

• Registry based

• Immediate case acquisition

• Real-time tracking of care

40 FORDS Data Items Assess all Measures

FIN

Accession Number

Sequence Number

Patient Zip Code at Dx

Clinical T

Clinical N

Pathologic T

Pathologic N

Tumor Size

Regional Nodes Ex

Regional Nodes Pos

ERA

PRA

Cancer Directed Surgery Date

Chemotherapy

Chemotherapy Date

Hormone Therapy

Hormone Date

Systemic Rx Date

Radiation Reg Rx Mod

Radiation Date

Reason for No Radiation

Last Contact Date

Vital Status

Class of Case

Sex

Age

Birth Date

Diagnosis Date

Primary Site

Tumor Histology

Tumor Behavior

Clinical M

Clinical Stage Group

Pathologic M

Pathologic Stage Group

Primary Site Surgery

Race / Hispanic Origin

Primary Payer

66 Test Sites

4 Centersin CT

27 Centers in GA

13 Centers in NJ

16 NCI NCCCP Pilot Sites

Linkage of NCDB with Administrative Data

• Physician records / billing data

• Other quality projects (e.g. ASCO QOPI)

• Payer claims

• Electronic health record

• Integration with guidelines (NCCN)

Enhancing Cancer Registry Treatment Data Through Linkage with Administrative Claims: Case

Matching and Surgical Care

S Edge2, K Mallin1, B Palis1, A Stewart1, N Watroba2, J Roistacher2, D Walczak3, J Barron4,

J Rogers5, W Blumenthal5

American College of Surgeons (1)Roswell Park Cancer Institute (2)

Optum Health (3)Healthcore (4)

Centers for Disease Control and Prevention (5)

Supported by CDC contract through Northrop GrummanRFP CIO-SP2-2305-BMH-ACS

to American College of Surgeons National Cancer Data Base:

Project in Ohio: Goals• Establish large scale linkage of private

claims to NCDB and OCISS

• Identify degree of completeness of registry treatment data compared to care identified in claims data

• Define quality of care– Core processes– Detailed components of care– Provide feedback to CoC programs

Claims and NCDB - Ohio:Participants and Scope

• Aggregated Claims from two payers:– United Health Care– Anthem Blue Cross Blue Shield

• Registry Data– National Cancer Data Base– Ohio Cancer Incidence and Surveillance System

• Breast, Colorectal, Lung cancer 2004 - 2006

Surgery - BreastSurgery by

NCDB Surgery by Claims

Surgery Type None BCS Mast Total

None / Unk 26 15 11 52

BCS 18 1386 66 1470

Mastectomy 1 9 792 802

Radiation Therapy - BreastClaims Radiation

Administered

NCDB - Radiation Administered No Yes Total

No 733 199 932

Yes 18 1374 1392

Total 751 1573 2324

Chemotherapy - BreastClaims Chemotherapy

AdministeredNCDB -

Chemotherapy Administered

No Yes Total

No 1005 152 1207

Yes 22 1095 1117

Total 1077 1247 2324

Endocrine Therapy - BreastClaims Endocrine

Administered

NCDB - Endocrine Administered No Yes Total

No 595 379 974

Yes 99 706 805

Total (missing 545) 694 1085 1779

Chemotherapy - ColorectalClaims Chemotherapy

AdministeredNCDB -

Chemotherapy Administered

No Yes Total

No 267 57 324

Yes 19 344 363

Total 286 401 687

NQF Quality Measure:Claims vs. Registry

Radiation with BCS

BCS by NCDB n = 859 Received Radiation

Source of Treatment Data Number Percent

NCDB 742 86%Claims 824 96%Both 831 97%

NQF Quality Measure:• RT with BCS within 1 yr of dx• Invasive cancer ; Age < 70• NCCN Benchmark 96%

Chemotherapy with Estrogen Receptor Negative Cancer

N = 266 Received ChemoSource of

Treatment Data Number Percent

NCDB 206 77%Claims 244 92%Both 252 95%

NQF Quality Measure:• Stage I-III ER negative; Age < 70• Chemo within 120 days of dx• NCCN Benchmark 91%

Claims Model• Private claims can be linked to the NCDB• High level agreement for surgical care• Claims provide more complete treatment data

for ambulatory care and more granular data

• Next steps:– Evaluation of lung cancer– Detailed care processes– Extend model

• All claims states• National

– Realtime claims matching with “RQRS” model

Conclusions:

• CoC has only existing system for collection of quality data and feedback to providers for quality improvement

• NCDB requires reengineering for– Rapid case identification and accrual– Linkage with other sources including claims

and EHR

Thank you!Thank you!