Data Qualtiy Management and Review

—Malnar K, Phillips JL, Fritz A, Fleming I, Landis SH, McKee R, White M, Stewart AK, Douglas L.  Quality of oncology data: Findings from the Commission on Cancer PCE study.  J Reg Mgmt 2001; 28:24-34.

—Sylvester J, Blankenship C, Carter A, Douglas L, Stewart AK.  Quality control: the American College of Surgeons Commission on Cancer Standards, National Cancer Data Base, and Cancer Liaison Program.  J Reg Mgmt  2000; 27:68-74.

—Fleming ID, Phillips JL, Menck HR, Murphy GP, Winchester DP. The National Cancer Data Base report on recent hospital cancer program progress toward complete American Joint Committee on Cancer / TNM staging. Cancer 1997; 80(12):2305-10. (!)

American Joint Committee on Cancer (AJCC) staging procedures were first published in 1977. Since 1991, the Commission on Cancer (COC) has required AJCC staging of all non-pediatric cancers. The National Cancer Data Base (NCDB) has encouraged recording of AJCC staging through analyses of selected aspects of staging completeness. For this review, NCDB reports for nearly 2 million stageable cancers diagnosed from 1990 through 1994 were examined with emphasis on the hospital cancer program environment. Staging was complete if the hospital submitted codes for at least 90% of stageable cases or absent if the hospital submitted codes for fewer than 5%. (Stageable cases were those cases having site-histology combinations with defined staging procedures). Hospitals were classified by ownership and type of cancer program. Regional staging practices were also reviewed. Overall staging increased from 78% to 88%, with increases for every site except carcinomas of the skin, cancers of the extrahepatic bile ducts and urethra, melanoma of the eyelid, and retinoblastoma. The percent of hospitals staging completely increased from 49% to 61%, and the percent not routinely staging decreased from 6% to 3%. Complete staging increased in all hospital categories except For-Profit. The trend toward complete staging was uneven among states and regions. The authors concluded that hospital staging policies were affected by activities of the AJCC, COC, NCDB, clinical protocol procedures, and state policies. The varied completeness of staging at the hospital level by state, region, and type of hospital indicates that the adoption of routine staging is ongoing.

—Eberle C, Phillips JL, Tary P, Menck HR. Quality management in the national cancer data base: a re-abstracting study of the midwest region. J Registry Management 1997; Aug:93-7 (!)

—Fleming ID, Phillips JL, Menck HR. The National Cancer Data Base report on completeness of American Joint Committee on Cancer staging in United States cancer facilities. Cancer 1996; 78:1498-504. (!)

American Joint Committee on Cancer (AJCC) staging is increasingly accepted as a prognostic standard for cancer management. The Commission on Cancer requires approved cancer programs to use AJCC staging for all cancers. Previous studies document the increasing use of AJCC staging by hospitals with cancer programs. This review examined programmatic and clinical factors affecting AJCC staging completeness. The data were registry records submitted to the National Cancer Data Base for cases diagnosed during 1993 or, for comparison, 1988. The mean facility staging rate was 87% in 1993, up from 65% in 1988. Approximately 64% of facilities staged more than 90% of their stageable cases (cases having site-histology combinations with defined staging procedures); 3% staged less than 5% of stageable cases. Even facilities with "complete" staging implementation were unable to stage substantial portions of some sites. Accessibility of tumor and overall prognosis affected the choice between pathologic and clinical staging. Staging completeness and the mix of pathologic and clinical staging also differed by state of reporting facility. AJCC staging use is high among common tumors for which treatment is dependent upon stage of disease. However, if accurate staging is not expected to affect the treatment or outcome of the case or overall outcome is poor, staging is less frequently recorded.

—Capron S. Working with EDITS. J Registry Management June 1995.

—Clive RE, Zuber-Ocwieja KE, Karnell LH, Hoyler SS, Seiffert JE, Young JL, Henson DE, Winchester DP, Osteen RT, Menck HR, Fremgen AM. A national quality improvement effort: Cancer registry data. J Surg Onc 1995; 58:155-161. (*)

Cancer registries are sources of epidemiological, patterns-of-care, and outcome data for local, regional, state, and national studies of patients with cancer. Since 1976, these registries have formed a voluntary network of contributors to annual patient care studies under the aegis of the National Cancer Data Committee of the Commission on Cancer. These annual studies provide timely clinical information that is widely disseminated to physicians, allied health personnel, administrators, health care planners, and public and private agencies. The use of the data has grown exponentially and has been the basis for more than 90 publications. Merging this activity with the National Cancer Data Base has further expanded the demand and use of registry data. This study was undertaken to respond to inquiries as to the validity of the data and the qualifications and competency of cancer registrars. It provides the baseline for cancer registry data quality and serves as a quality management tool to identify opportunities to enhance data quality.

—Smart CR, Karnell LH, Eberle C, Zippin C, Lum D, Clive RE, Zuber-Ocwieja KE. Quality control. In: Steele GD, Winchester DP, Osteen RT, Menck HR, Murphy GP: eds. National Cancer Data Base: Annual review of patient care, 1994. Atlanta, GA: American Cancer Society, 1994; 117-126.

In addition to the Annual Call for Data, the NCDB issued 3 quality management surveys to assess quality management of data in the reporting institutions. The UCSF study focused on the accuracy, consistency, and completeness of cancer registry data. The Re- abstracting Study examined breast, colorectal, prostate, childhood cancers, and melanoma in on-site reabstracting activities. The Quality Control PCE study assessed standardization by asking all participating cancer registrars to abstract the same 25 cases. Collectively, the three studies recommended a continued focus on the importance of abstract review, registrar training and certification, and use of staging forms. In addition, the results suggested establishing a liaison between the oncology community and the College of American Pathologists to encourage standardization of the pathology report.

—Eberle C. Benchmarking - An Oncology Tool Already in Place, Newsbreak, Illinois Health Information Management Association, 1994.

—NCDB/NTRA Task Force for Quality Improvement. Advanced Quality Improvement Workshop, Faculty Course Materials, Chicago, Illinois, American College of Surgeons, 1993.

—NCDB/NTRA Task Force for Quality Improvement. Advanced Quality Improvement Workshop, Student Workbook, Chicago, Illinois, American College of Surgeons, 1993.

—Smart CR, Eberle C, Simon S. An assessment of National Cancer Data Base quality control. In: Steele GD, Winchester DP, Menck HR, Murphy GP: eds. National Cancer Data Base Annual review of patient care, 1993. Atlanta, GA: American Cancer Society, 1993; 103-115.

Thirty-nine randomly selected hospitals from 9 regions of the United States provided information on 195 cancer cases. A certified tumor registrar audited the submitted data as a quality control measure. Of the 195 cases audited, 79% were adequate for review and 21% were excluded because of the unavailability of the medical record, incomplete records, missing information from another facility, or incorrect records. More than 88% of the remaining 154 cases were complete. Overall, the disagreement rate was 6.7%. The highest and most troublesome disagreement rates were 27.5% for AJCC pathologic staging and 21.0% for surgery performed. Discrepancies in the date of diagnosis were generally differences in the exact date or the exact procedure that determined the date of diagnosis.

 

Clinical Infomation Bibliography