CASEFINDINGCASEFINDING

Debra W. Christie, MBA, RHIA, CTR, Debra W. Christie, MBA, RHIA, CTR, CCRPCCRP

Director, Cancer Research & Data CenterDirector, Cancer Research & Data CenterUniversity of Mississippi Medical CenterUniversity of Mississippi Medical Center

CasefindingCasefinding

• Systematic process to identify all cases Systematic process to identify all cases eligible to be included in the registry eligible to be included in the registry databasedatabase

• Includes both inpatients and outpatients Includes both inpatients and outpatients • Required at all types of facilitiesRequired at all types of facilities• Need an up to date Reportable ListNeed an up to date Reportable List

Reportable ListReportable List

• Include all malignancies (carcinomas, Include all malignancies (carcinomas, sarcomas, melanoma, leukemia, sarcomas, melanoma, leukemia, lymphomaslymphomas

• Benign brain tumors (must be reported as Benign brain tumors (must be reported as of 1/1/2004)of 1/1/2004)

• Cases reportable by agreement (ACOS Cases reportable by agreement (ACOS hospital cancer programs)hospital cancer programs)

What Should be Reported in What Should be Reported in Mississippi?Mississippi?• Analytic cases diagnosed on or after Analytic cases diagnosed on or after

January 1, 1996January 1, 1996• Cases that were diagnosed and/or treated Cases that were diagnosed and/or treated

at your facility (on or after 1/1/96)at your facility (on or after 1/1/96)• Pathology only cases read by pathologists Pathology only cases read by pathologists

must be reportedmust be reported• Nonanalytic cases – submit when Nonanalytic cases – submit when

requested by MCRrequested by MCR

Additional Cases to ReportAddit ional Cases to Report

• Squamous intraepithelial neoplasia grade Squamous intraepithelial neoplasia grade III of the following:III of the following:– Vulva (VIN)Vulva (VIN)– Vagina (VAIN)Vagina (VAIN)– Anus (AIN)Anus (AIN)

• Refer to the state reportable listRefer to the state reportable list

Mississippi - Do Not Mississippi - Do Not ReportReport• History of Cancer Cases History of Cancer Cases

• Basal cell and squamous cell carcinomas Basal cell and squamous cell carcinomas of the skinof the skin

Types of CasefindingTypes of Casefinding

• Active casefindingActive casefinding– More thoroughMore thorough– More accurateMore accurate– Costs moreCosts more

• Passive casefindingPassive casefinding– Self reporting less reliableSelf reporting less reliable– Dependent on others to ID casesDependent on others to ID cases– More likely to miss casesMore likely to miss cases

Casefinding SourcesCasefinding Sources

• Methods vary by individual facilityMethods vary by individual facility

• Depends on services offered at facilityDepends on services offered at facility

• Multiple sources needed to identify all Multiple sources needed to identify all casescases

Casefinding Sources Casefinding Sources ContinuedContinued

• Pathology, cytology reportsPathology, cytology reports• Admission/discharge documentsAdmission/discharge documents• Disease indices/coding reportsDisease indices/coding reports• Surgery scheduleSurgery schedule• Nuclear medicine logsNuclear medicine logs• Radiation treatment logsRadiation treatment logs

Casefinding Sources Casefinding Sources ContinuedContinued

• Hematology or Oncology clinic Hematology or Oncology clinic appointment schedulesappointment schedules

• Bone marrow reportsBone marrow reports• Mammography reportsMammography reports• CT/MRI reportsCT/MRI reports• Autopsy reportsAutopsy reports

Pathology & Cytology ReportsPathology & Cytology Reports

• >90% of cases>90% of cases• Review copies reportsReview copies reports• Computer generated listing – specify Computer generated listing – specify

codescodes• Outside cases reviewed by pathologist Outside cases reviewed by pathologist

Admission/Discharge Admission/Discharge DocumentsDocuments

• Daily or weekly reviewDaily or weekly review

• Can be done at time discharge records Can be done at time discharge records processedprocessed

• May be a computer generated list of May be a computer generated list of patients patients

Admission/Discharge ListAdmission/Discharge List

NameName MR #MR # ServServ DcDateDcDate ICD-9 ICD-9 CodeCode

L name, 7777 Med 9-1-05 174.9L name, 7777 Med 9-1-05 174.9FirstFirst

• Sort according to your specificationsSort according to your specifications

Disease Indices/CodingDisease Indices/CodingReportsReports

• Run monthly, depending on case loadRun monthly, depending on case load• May be hard copy or electronicMay be hard copy or electronic• Based on cases codedBased on cases coded• Obtain from health information Obtain from health information

management/medical record departmentmanagement/medical record department

Disease Index – October 2005Disease Index – October 2005

NameName MR#MR# DCDateDCDate PrimDxPrimDx SecDxSecDx

Jones R 88888 10/15/05 174.9 197.0Jones R 88888 10/15/05 174.9 197.0

May S 77777 10/18/05 V58.1 162.4May S 77777 10/18/05 V58.1 162.4

Wade W 11111 10/09/05 185Wade W 11111 10/09/05 185

Surgery ScheduleSurgery Schedule

• Type of procedureType of procedure

• ExamplesExamples– Modified radical mastectomyModified radical mastectomy– Radical prostatectomyRadical prostatectomy

• Especially important for outpatient surgery Especially important for outpatient surgery centerscenters

Nuclear Medicine LogNuclear Medicine Log

• Bone scansBone scans

• I-131 treatment for thyroid cancerI-131 treatment for thyroid cancer

Radiation Treatment LogsRadiation Treatment Logs

• Patients treated with radiationPatients treated with radiation

• Patient may have been diagnosed Patient may have been diagnosed elsewhereelsewhere

• Patients may be included with disease Patients may be included with disease index/coding list (need to know how index/coding list (need to know how coding is handled at facility)coding is handled at facility)

Hematology or Oncology Hematology or Oncology VisitsVisits

• Hematology or Oncology clinic on siteHematology or Oncology clinic on site

• Patients may not be admitted to hospitalPatients may not be admitted to hospital– Chronic lymphocytic leukemiaChronic lymphocytic leukemia– Polycythemia VeraPolycythemia Vera

• Diagnosis by CBC or other blood testDiagnosis by CBC or other blood test

Bone Marrow ReportsBone Marrow Reports

• Report may be generated by pathology or Report may be generated by pathology or hematologisthematologist

• Leukemias, myeloproliferative disorders, Leukemias, myeloproliferative disorders, other malignanciesother malignancies– Chronic lymphocytic leukemiaChronic lymphocytic leukemia– Refractory anemiaRefractory anemia– Lymphoma involving the bone marrowLymphoma involving the bone marrow

MammographyMammography

• Abnormal mammogramsAbnormal mammograms

• Work with radiologists to identify cases Work with radiologists to identify cases that fit criteria for cancer diagnosis (i.e., that fit criteria for cancer diagnosis (i.e., compatible with, suspicious, probable for compatible with, suspicious, probable for cancer – see reportable list)cancer – see reportable list)

CT & MRI ReportsCT & MRI Reports

• Clinical diagnosis of cancerClinical diagnosis of cancer• Benign brain tumorsBenign brain tumors

– Pituitary adenomaPituitary adenoma– MeningiomaMeningioma

• Brain metastasisBrain metastasis• Work with radiologists to identify cases that fit Work with radiologists to identify cases that fit

criteria for cancer diagnosis (i.e., compatible criteria for cancer diagnosis (i.e., compatible with, suspicious, probable for cancer – see with, suspicious, probable for cancer – see reportable list) reportable list)

Autopsy ReportAutopsy Report

• May confirm primary site (unknown May confirm primary site (unknown primary)primary)

• New cancer not diagnoses previously may New cancer not diagnoses previously may be identifiedbe identified– Prostate cancer, incidental findingProstate cancer, incidental finding

Casefinding – State Casefinding – State RegistryRegistry• HospitalsHospitals• Independent Pathology LaboratoriesIndependent Pathology Laboratories• Freestanding Radiation FacilitiesFreestanding Radiation Facilities• Physician OfficesPhysician Offices

– Hematology/OncologyHematology/Oncology– DermatologyDermatology– UrologistUrologist– NeurologistNeurologist– RadiologistRadiologist

Casefinding – State Casefinding – State RegistryRegistry• Outpatient Surgery Center, freestandingOutpatient Surgery Center, freestanding• HospiceHospice• Nursing HomesNursing Homes• Death CertificatesDeath Certificates• Others?Others?

Review/Link Identif ied Review/Link Identif ied CasesCases• Compare site in registry database – new Compare site in registry database – new

versus prior malignancyversus prior malignancy

• Identify subsequent malignanciesIdentify subsequent malignancies

Enter Patient in Suspense Enter Patient in Suspense FileFile• Cases that are potentially reportableCases that are potentially reportable

• Cases that need to be abstractedCases that need to be abstracted

• Include - Name, Identifier, Date of first Include - Name, Identifier, Date of first contact/Diagnosis Date, Primary sitecontact/Diagnosis Date, Primary site

• File/sort by date identifiedFile/sort by date identified

Monitor Casefinding Monitor Casefinding CompletenessCompleteness

• Quality control functionQuality control function• Maintain a casefinding logMaintain a casefinding log• Review number of cases by monthReview number of cases by month• Review number of cases by casefinding Review number of cases by casefinding

sourcesource• Look at primary site totalsLook at primary site totals

Casefinding AuditsCasefinding Audits

• Completed by State Registry or other Completed by State Registry or other entitiesentities

• Assess completeness of casefindingAssess completeness of casefinding

SummarySummary

• Casefinding is an important procedure to Casefinding is an important procedure to identify casesidentify cases

• Identify facility specific methods to identify Identify facility specific methods to identify casescases

• Monitor casefinding for quality controlMonitor casefinding for quality control