Download Casefinding & Follow-Up

Casefinding &
Follow-Up
Dolores E. McCord,
RHIT, CTR
Piedmont Hospital
Atlanta, Georgia
Follow-Up and
Casefinding
Inter-related Procedures
Casefinding leads to follow-up
Follow-up leads to casefinding
September 30, 2004
2004 GATRA Educational Conference
2
Casefinding – Sources
No casefinding, no registry
Pathology Department – a MUST
Surgical reports
– Hospital patient
– Physician office
– Path only
Cytology
Bone marrows
Autopsy Reports
September 30, 2004
2004 GATRA Educational Conference
3
Casefinding – Sources
No casefinding, no registry
Medical Record Indices – a MUST
Outpatient Departments
Radiation Therapy
Infusion Therapy / Chemotherapy
Others?
September 30, 2004
2004 GATRA Educational Conference
4
Casefinding
Multiple sources – to find
Nothing
New patient, new diagnosis
Existing patient, new diagnosis,
follow-up of existing diagnosis
Existing patient, existing diagnosis,
recurrent or progression, follow-up
Existing patient, existing diagnosis,
no change, follow-up
September 30, 2004
2004 GATRA Educational Conference
5
Casefinding
History of, existing cases – troublemakers
Why patient in hospital system with cancer
codes?
What if the biopsy was negative? What
were they trying to find?
Ruling out presence of cancer?
Trying to confirm presence of cancer,
suspected?
What about x-rays, scans? What are they
looking for?
Bigger question: How far do you go?
September 30, 2004
2004 GATRA Educational Conference
6
Follow-Up
The reason the hospital registry
exists.
Finds recurrences and new
primaries for existing patients
Requires resources, time, and
diligence.
Provides the real value for registry:
patient outcome.
September 30, 2004
2004 GATRA Educational Conference
7
Follow-Up
Is the patient still alive?
Simple question – answered,
Yes
No.
The patient is dead – end of story?
ICD Cause of Death: to code or not
to code. That is the question.
September 30, 2004
2004 GATRA Educational Conference
8
Follow-Up
Is the cancer present, or was
present at last contact/death?
Not so simple.
Never Disease-Free Cancers:
Unknown Primaries, distant
metastases at diagnosis.
Can the cancer go away?
Is the patient clinically without evidence
of disease – per physician?
Recurrent Cancers: did treatment
eradicate all cancer?
September 30, 2004
2004 GATRA Educational Conference
9
Follow-Up
Cancer status: 1, 2, or 9?
Last follow-up, cancer status: 1
Next follow-up, cancer status: 1?
Any evidence for recurrence?
Questionable status – rising markers,
uncertainty
September 30, 2004
2004 GATRA Educational Conference
10
Follow-Up
Cancer status: 1, 2, or 9?
Last follow-up, cancer status: 2
Next follow-up, cancer status: 2?
Did treatment eradicate all evidence of
cancer?
Where did it go?
September 30, 2004
2004 GATRA Educational Conference
11
Follow-Up
Cancer status 1, 2, or 9?
Last follow-up, cancer status: 9
Next follow-up, cancer status: __?
September 30, 2004
2004 GATRA Educational Conference
12
Follow-Up
COC Requirements
Patient status
Cancer status
Recurrence information
September 30, 2004
2004 GATRA Educational Conference
13
Follow-Up
Not Required by COC
Subsequent treatment
Specific metastatic site(s)
September 30, 2004
2004 GATRA Educational Conference
14
Follow-Up
Subsequent treatment –
completes the picture
Recurrences – what happened next?
Non-analytic cases – was cancer
care given?
Biopsy? More surgery? Radiation?
Chemotherapy? Palliative care?
Administrative reports – radiation, 1st
or 2nd course – a must!
September 30, 2004
2004 GATRA Educational Conference
15
Follow-Up
Recurrence information –
Metastatic Sites
Single site, specific code
Multiple sites, combination code –
lose information
Brain mets, at DX and at recurrence –
administrative reports
September 30, 2004
2004 GATRA Educational Conference
16
Follow-Up Process
Steps = Success
List due for follow-up
Hospital system: inpatients, outpatients,
ED
MQS
SSDI
Other?
September 30, 2004
2004 GATRA Educational Conference
17
Follow-Up Process
Steps = Success
Letters
Physicians: one vs. all
Patients
Other physicians?
Secondary contacts?
Last resorts – the phone
September 30, 2004
2004 GATRA Educational Conference
18
Follow-Up Letters
Patient Letters
Valuable information
New doctors
New address
Date of last contact – post mark date
Returned – Pain in the ____!
MLNA – address search
New address
September 30, 2004
2004 GATRA Educational Conference
19
Follow-Up Letters
Physician Letters
Not always reliable
Wrong dates, unknown info
Source for other physicians
Recurrence and subsequent
treatment information
Clinical trial inclusion
Keep physician contacts updated
September 30, 2004
2004 GATRA Educational Conference
20
Follow-Up Letters
Other Contact Letters
Rarely used
Varied response rates
Could be useful
September 30, 2004
2004 GATRA Educational Conference
21
Follow-Up Sources
Letters / Phone calls
Admissions / hospital service (CF)
Path reports (CF)
Clinic / outpatient visits (CF)
Internet sources
Death certificates
Obits
September 30, 2004
2004 GATRA Educational Conference
22
Follow-Up Rates
Two Measurements
Since reference date: 80%
Diagnosed last 5 years: 90%
No longer 80% of alive analytic
patients
No longer 90% of all analytic
patients
September 30, 2004
2004 GATRA Educational Conference
23
Follow-Up Rates
Who are not followed?
Non-analytic cases
CIS, CIN III, other III’s
Previously collected localized skins
Benign / borderline tumors
Foreign residents
Reportable by agreement
>100 years old, last contact >12
months
September 30, 2004
2004 GATRA Educational Conference
24
Follow-Up Rates
Who are lost?
“…delinquent if no contact has been
made with the patient within fifteen
months after the date of last
contact.”
Hutchison, C.L., S.D. Roffers, and A.G.
Fritz (eds.), Cancer registry
management: principles and practice.
Dubuque: Kendall/Hunt Publishing
Company, 1997, p. 137.
September 30, 2004
2004 GATRA Educational Conference
25
Follow-Up Rates
Who are lost?
Last Contact:
12 months:
13 months:
14 months:
15 months:
Lost 16 months:
September 30, 2004
June 2003
June 2004
July 2004
August 2004
September 2004
October 2004
2004 GATRA Educational Conference
26
Follow-Up Rates
Who are lost?
Current month:
12 months back:
13 months back:
14 months back:
15 months back:
16 months & lost:
September 30, 2004
October 2004
October 2003
September 2003
August 2003
July 2003
June 2003 & before
2004 GATRA Educational Conference
27
Casefinding and FollowUp
Made for each other!
One should always lead to the other.
Both time-consuming processes
Both basis for registry
September 30, 2004
2004 GATRA Educational Conference
28