Presented by: Sharon Winters Director, Registry Information Services UPMC Cancer Centers
description
Transcript of Presented by: Sharon Winters Director, Registry Information Services UPMC Cancer Centers
APIIIOctober 23, 2008
Establishing Indicators Establishing Indicators for Cancer Care:for Cancer Care:
The Role of the Cancer Registry The Role of the Cancer Registry and Other Oncology Data and Other Oncology Data
SourcesSources
Presented by:
Sharon WintersDirector, Registry Information Services
UPMC Cancer [email protected]
(412) 647-6390
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Session ObjectivesSession Objectives Understand the history of Pay for
Performance initiatives Identify organizations dedicated to the
evaluation of quality of care indicators Identify electronic medical data sources
being used to evaluate these indicators Create an open forum for discussion of
how pathology, cancer registry and other clinical applications can continue to play key roles
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Session OutlineSession Outline Identify the difference between Quality of Care
vs. Pay for Performance Brief review of Healthcare expenditures Identify organizations dedicated to the evaluation
of quality care indicators Specific focus on oncology care
Understand the history of Pay for Performance initiatives
Identify indicators accepted by the National Quality Forum and CMS
Identify electronic medical data sources being used to evaluate these indicators
Discussion
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Quality ManagementQuality Management A method for ensuring that all activities
necessary to design, develop and implement a product or service are effective with respect to the system and its performance.
Three main components: Quality Control Quality Assurance Quality Improvement
http://en.wikipedia.org/wiki/Quality_improvement
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What is meant by “Quality What is meant by “Quality of Care”?of Care”? The degree to which health services for individuals and
populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge. U.S. Institutes of Medicine (IOM)
Each individual consumer should receive the best possible health care available every time services are needed.
Health care providers should provide care that meets the needs of each individual patient, including the use of appropriate advances in medical technology.
Healthcare should also be non-discriminatory, providing the same quality of service regardless of race, ethnicity, age, sex or health status. http://www.medicareadvocacy.org/
http://www.iom.edu/
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What’s in a Name?What’s in a Name? Quality Management Quality Assurance Continuous Process Improvement Total Quality Improvement Clinical Indicators of Care Quality Indicators of Care Clinical Pathways
Incorporating multidisciplinary approach to surgical oncology, medical oncology, radiation oncology and clinical therapeutic trials
http://www.oncbiz.com/documents/OBRJA07_Pathways.pdf
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The “Cost” of Health CareThe “Cost” of Health CareIncreasing Overall NHE 1960-2006Increasing Overall NHE 1960-2006
U.S. National Healthcare Expenditures
$0.00
$500.00
$1,000.00
$1,500.00
$2,000.00
$2,500.00
1960 1970 1980 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006
in B
illi
on
s
http://www.cms.hhs.gov/NationalHealthExpendData/
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The “Cost” of Health CareThe “Cost” of Health CarePercent by Type of Service 1994 Percent by Type of Service 1994 vs. 2004vs. 2004
34.1
30.4
21.821.3
5.6
10
76.1
2.7 2.3
13 12.9
15.716.9
0
5
10
15
20
25
30
35
%
Hospital Care Physician/ClinicalServices
Prescription Drugs Nursing Home Care Home Health Care Other Personal Care Other HealthSpending
U.S. National Healthcare Expenditures % by Type of Service
1994 2004
http://www.cms.hhs.gov/NationalHealthExpendData/
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Pay for Performance Pay for Performance (P4P)(P4P) Insurance companies, large corporations
providing health benefits to their employees, Medicare, and other healthcare purchasers are looking to improve the quality of healthcare and control costs by changing the way they pay for healthcare paying doctors, hospitals, and other providers
more for high quality care, and less for poor quality care
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The OrganizationsThe Organizations…or shall we say, the acronyms?…or shall we say, the acronyms? Joint Commission on Accreditation of Healthcare Organizations (JCAHO) Centers for Medicare and Medicaid Services (CMS) National Quality Forum (NQF) US Department of Health and Human Services (USDHHS)
Agency for Healthcare Research and Quality (AHRQ) National Comprehensive Cancer Network (NCCN) American Society of Clinical Oncology (ASCO) American College of Surgeons Commission on Cancer (ACoS CoC) Centers for Disease Control and Prevention (CDC) American Medical Association (AMA) College of American Pathologists (CAP) American Cancer Society (ACS) Center for Health Care Strategies (CHCS)
Insurance Companies State Specific Initiatives
Quality Insights of Pennsylvania Pennsylvania Cancer Control Consortium (PAC3) Pittsburgh Regional Health Initiative (PRHI)
Disease-specific organizations ….and many others
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Reportable Cases by Reportable Cases by Insurance TypeInsurance Type2000-20072000-2007
UPMC Hospital Based Cancer Cases by Insurance Type
CY 2000-2007
Medicare36%
Military/VA, Indian/Public Health
Service, Tricare0%
Medicaid2%
Not Insured, Self Pay1%
Private48%
Other Insurance, NOS or Unknown Status
13%
86% of cancer care is covered by Medicare/Medicaid and Private Insurance
Source: UPMC Network Cancer Registry Via Hospital billing systems
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Cancer Care Indicators and Cancer Care Indicators and P4PP4P“Recent” History“Recent” History 1999: Institute of Medicine report “Ensuring Quality
Cancer Care” Revealed lack of info on the quality of cancer care Recommended development of better measures and data to
support evaluation In response, NCI teams up with several agencies to contract
with the National Quality Forum (NQF) Agency for Health Care Research and Quality (AHRQ) Centers for Disease Control (CDC) Centers for Medicare and Medicaid Services (CMS)
2004: American College of Surgeons supports use of NCCN and ASCO benchmark guidelines for breast and colorectal cancers
2004 and 2005: NQF announces call for breast and colorectal measures NQF contracts with the American College of Surgeons
Commission on Cancer
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Cancer Care Indicators Cancer Care Indicators and P4Pand P4P “Recent” History (Continued)“Recent” History (Continued) January 2005: Medicare (CMS) releases “Pay for
Performance” Initiatives (P4P) – this is working its way into cancer care… Linking level of payment to reporting of quality measures Some initiatives also provide for ‘bonus’ payments
2% above standard DRG payment for facilities scoring in the top 10% of “highest quality”
1% above standard DRG payment for next highest 10% April 2007: NQF Endorses American College of Surgeons
Commission on Cancer (CoC) Measures for Cancer Care of Breast and Colorectal Cancers Out of 8 measures proposed by the CoC, 5 measures met the
requirements of the NQF Steering Committee 3 for breast cancer 2 for colon cancers
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Pay for Performance Pay for Performance MeasuresMeasuresConditions for ConsiderationConditions for Consideration Be in a public domain or have a signed
intellectual property (IP) agreement to make open source
Have an identified responsible entity and process to maintain and update the measure
Be intended for both public reporting and quality improvement
Be fully developed and tested so that all evaluation criteria have been addressed and information needed to evaluate the measure is provided
http://www.qualityforum.org/
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NQF, ASCO/NCCN and CoC NQF, ASCO/NCCN and CoC Adopted Indicators: Breast Adopted Indicators: Breast Cancer #1Cancer #1 Radiation therapy is administered within 1 year
(365 days) of initial diagnosis for women under the age of 70 receiving breast conserving surgery for breast cancer. Denominator includes: Gender = women Age at dx = 18-69 at time of diagnosis Known or assumed first or only cancer diagnosis Primary breast tumors Epithelial invasive tumors AJCC stage = I, II or III BC Surgery = excision less than mastectomy All or part of the first course of tx performed at reporting
facility Known to be alive within 1 year (365 days of dx)
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NQF, ASCO/NCCN and CoC NQF, ASCO/NCCN and CoC Adopted Indicators: Breast Adopted Indicators: Breast Cancer #2Cancer #2 Chemotherapy is considered or administered
within 4 months (120 days) of diagnosis for women under 70 with AJCC T1cN0M0 or Stage II/III hormone receptor negative breast cancer. Denominator includes: Gender = women Age at dx = 18-69 at time of diagnosis Known or assumed first or only cancer diagnosis Primary breast tumors Epithelial invasive tumors AJCC stage = T1cN0M0 or stage II/III ER neg (-) and PR neg (-) All or part of the first course of tx performed at reporting
facility Known to be alive within 4 months (120 days) of diagnosis
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NQF, ASCO/NCCN and CoC NQF, ASCO/NCCN and CoC Adopted Indicators: Breast Adopted Indicators: Breast Cancer #3Cancer #3 Tamoxifen or 3rd generation aromatase
inhibitor is considered or administered within 1 year (365 days) of diagnosis for AJCC T1cN0M0 or Stage II/III hormone receptor positive breast cancer. Denominator includes: Gender = women Age at dx >= 18 at time of diagnosis Known or assumed first or only cancer diagnosis Primary breast tumors Epithelial invasive tumors AJCC stage = T1cN0M0 or stage II/III ER positive (+) or PR positive (+) All or part of the first course of tx performed at reporting
facility Known to be alive within 1 year (365 days) of diagnosis
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NQF, ASCO/NCCN and CoC NQF, ASCO/NCCN and CoC Adopted Indicators: Colon Adopted Indicators: Colon Cancer #1Cancer #1 Adjuvant chemotherapy is considered or
administered within 4 months (120 days) of diagnosis for patients under the age of 80 with AJCC Stage III (lymph node positive) colon cancer. Denominator includes: Age = 18-79 at time of initial diagnosis Known or presumed to be the first or only cancer
diagnosis Primary tumors of the colon Epithelial invasive malignancies only AJCC Stage III All or part of the first course of treatment performed at
reporting facility Known to be alive within 4 months (120 days) of diagnosis
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NQF, ASCO/NCCN and CoC NQF, ASCO/NCCN and CoC Adopted Indicators: Colon Adopted Indicators: Colon Cancer #2Cancer #2 At least 12 regional lymph nodes are
removed and pathologically examined for resected colon cancer. Denominator includes: Age >=18 at time of initial diagnosis Known or presumed to be the first or only cancer
diagnosis Primary tumors of the colon Epithelial invasive malignancies only AJCC Stage I, II or III Surgical resection performed at reporting facility
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ASCO and CoC Adopted ASCO and CoC Adopted Indicators: Indicators: Rectal CancerRectal Cancer Radiation therapy is considered or administered
within 6 months (180 days) of diagnosis for patients under the age of 80 with clinical or pathological AJCC T4N0M0 or Stage III receiving surgical resection for rectal cancer. Denominator includes: Age =18-79 at time of initial diagnosis Known or presumed to be the first or only cancer
diagnosis Primary tumors of the rectum Epithelial invasive malignancies only AJCC clinical or pathologic Stage T4N0M0 or Stage
III All or part of the first course of treatment performed at
reporting facility Known to be alive within 6 months (180 days) of diagnosis
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Data Collection to Support Data Collection to Support IndicatorsIndicators American College of Surgeons Commission on
Cancer National Cancer DataBase (NCDB) 75% of all newly dx cancer cases in U.S. annually Over 20 million cases reported since 1985 – from data
collected/reported by cancer registries in approved facilities Jointly supported by CoC and American Cancer Society Several “SubReports” available
Public Benchmark Reports Survival Reports Hospital Comparison Benchmark Reports Cancer Program Practice Profile Reports (CP3R) – focused
on adjuvant chemo admin for Stage III cancer of the colon (colon indicator #1): comparative data available
Electronic Quality Improvement Packets (e-QuIP) – focused on the 3 breast indicators and colon indicator #1 and rectal indicator, however only facility-specific data is available
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How are we doing?How are we doing? (2003-2005 data)(2003-2005 data)
Indicator Summary Hospital 1 Hospital 2Br1: rad for BCS 939/961
97.7%165/17793.2%
Br2: chemo for HR(-) 222/22399.6%
29/3096.7%
Br3: hormone for HR(+) 964/98997.5%
160/16895.2%
Col1: chemo for Stage III(CP3R)
NA 99/12579.2%
Col2: >=12 RLN removed NA 210/32365.0%
Rectal: rad for T4, stage III NA 62/6398.4%
Source: eQuIPs and CP3R
Hospital 2 eQuIPs data updated 01/22/08; Hospital 1 updated 01/31/08
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What happens next?What happens next? With the NQF endorsement of breast and
colon cancer indicators, and the Centers for Medicare and Medicaid Services (CMS) exploring precursors to P4P, the CoC programs are well positioned to understand needed areas for improvement and should be acting on deficiencies.
Additional indicators will be recommended, evaluated for top sites/rare cancers
Even if your facilities does NOT have a CoC approved cancer program……
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Pennsylvania Cancer Pennsylvania Cancer Control Consortium Control Consortium (PAC3)(PAC3) In 2001 an unprecedented partnership was initiated in
Pennsylvania by the Pennsylvania Department of Health to develop the Commonwealth’s first-ever comprehensive cancer control plan in response to the Centers for Disease Control and Prevention’s very ambitious challenge – to eliminate suffering and death due to cancer by the year 2015
PAC3 Priority Indicators Chemotherapy is recommended/administered for Stage III
(regional LN positive) colon cancer At least 12 regional lymph nodes are removed for Stage I-III
colon cancer Using PA Cancer Registry data obtained from facility based
registries and pathology labs Preliminary data reported at October 2007 PAC3 meeting
and ongoing evaluation/manuscript in progress see next slides
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PAC3: Why Focus On PAC3: Why Focus On Colorectal Cancer Colorectal Cancer Treatment?Treatment? In 2004, colorectal cancer had the 3rd highest number of
new cases for men and 3rd highest for women.
However, in 2004 and 2005, colorectal cancer mortality was ranked 2nd behind bronchus and lung cancer for both men and women.
Colorectal cancer is highly treatable and recent research and clinical trials have shown that there is a correlation between adjuvant chemotherapy following surgery and the number of lymph nodes tested to cancer recurrence and mortality of patients.
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PAC3: Colon Cancer and PAC3: Colon Cancer and Chemotherapy BackgroundChemotherapy Background Clinical trials conducted in the 1980s established that
postoperative chemotherapy treatment for stage III colon cancer patients reduces the risk of recurrence and mortality by as much as 30 percent (1,2).
The National Institutes of Health (NIH) released a consensus statement in 1990, which has led to adjuvant chemotherapy being the standard of care for stage III colon cancer patients after surgery (3).
An analysis from the Mayo Clinic (4) showed that the benefits of chemotherapy on older patients (over age 70) decreases only slightly with increased age.
The National Cancer Institute’s (NCI) webpage for Colon Cancer: Treatment states that recurrence of colorectal cancer after surgery is a major problem and is often the ultimate cause of death.
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Percent of All Stage III Colorectal Cancer Patients Who Did Not Receive Chemotherapy (RX Chemo Code = '00')
PA Cancer Registry Data 2004-2005
9.4%12.9%
18.4%
31.5%
53.6%
0.0%
10.0%
20.0%
30.0%
40.0%
50.0%
60.0%
Age 0 to 49 Age 50 to 64 Age 65 to 74 Age 75 to 84 Age 85 and older
Perc
en
t
203 / 379173 / 939
RX Chemo Codes Cases99 3788 1887 1786 285 482 3903 1102 4301 500 203
347 / 1,100
RX Chemo Codes Cases99 7188 5587 5086 985 982 4803 21602 26101 3400 347
RX Chemo Codes Cases99 4888 5087 2486 1085 382 603 35702 21101 5700 173
116 / 90031 / 331
RX Chemo Codes Cases99 3088 4387 986 585 282 203 45702 17701 5900 116
RX Chemo Codes Cases99 688 1287 286 485 182 103 20202 4601 2600 31
NQF measure cut off
at age 80
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Elk
York
Centre
Berks
Pike
Butler
Lycoming
Bedford
Clinton
Clearfield
Indiana
Somerset
Blair
Luzerne
Fayette
Perry
Lancaster
Mercer
Bucks
Chester
Franklin
Clarion
Cambria
Monroe
Greene
Schuylkill
Venango
Huntingdon
Adams
Washington
Westmoreland
Jefferson
Fulton
Mifflin
Dauphin
Beaver
Armstrong
Sullivan
Union Carbon
Lehigh
Snyder
Tioga
Erie
PotterBradfordWarren McKean
CrawfordWayne
Allegheny
Forest
Susquehanna
Juniata
Columbia
Cumberland
CameronWyoming
Lebanon
Montgomery
Lawrence
Lackawanna
NorthumberlandNorthampton
Delaware
Montour
Philadelphia
Percent of Stage III Colorectal Cancer Cases Where Patients Did Not Receive ChemotherapyWith Hospitals With Chemotherapy Services
Pennsylvania Cancer Registry Data (2004 - 2005)
Percent
0.0 % 0.1% - 25.0% 25.1% - 50.0% 50.1% - 75.0% 75.1% - 100.0%
NOTE: The color shading and percentages are based on the ratio of the number of stage III (AJCC staging definition) colorectal cancer cases where chemotherapy was not received (chemo code = '00') and the total number of stage III colorectal cancer cases where there is no valid reason why chemotherapy was not administered OR where chemo WAS administered (chemo codes = '00', '01', '02', or '03').
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PAC3: Colon Cancer and PAC3: Colon Cancer and Lymph Node Examination Lymph Node Examination BackgroundBackground The American Joint Committee on Cancer and a NCI panel
recommended that at least 12 lymph nodes be examined in colon cancer patients to confirm the absence of nodal involvement by tumor.
Recent PCR numbers show that more than 60% of patients do not have the recommended 12+ nodes examined.
Screenings for colon cancer are recommended to become routine for adults age 50 or older; however, PCR numbers show that 6% of colon cancer cases leading to surgery were in patients under the age of 50.
Studies have shown that an increased number of lymph nodes examined have led to an increased survival rate, especially in earlier staged cancer.
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PAC3: QuestionsPAC3: Questions How many lymph nodes are really needed,
and what is the cut-off? Who should decide how many nodes to
examine, the surgeon or the pathologist? Are patients being staged properly? Does the location of the cancer in the
colon have an effect? Does age, race, or sex play a role in how
many nodes should be examined?
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0%
5%
10%
15%
20%
25%
30%
35%
40%
45%
50%
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30
Number of Lymph Nodes Examined
Per
cent
of C
olon
Can
cer
Cas
es W
ithL
ymph
Nod
es F
ound
Pos
itive
Percent of Colon Cancer Cases With Lymph Nodes Found PositiveBy Number of Lymph Nodes Examined (Stage 0, I, II, and III),
With Trend Line, Pennsylvania (2004 - 2005)
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Elk
York
Centre
Berks
Lycoming
Bedford
Butler
Somerset
Pike
Clinton
Clearfield
Luzerne
Fayette
Indiana
Lancaster
Bucks
Blair
Chester
Perry
Franklin
Venango
Schuylkill
Greene
Clarion
Monroe
Cambria
Huntingdon
Allegheny
Washington
Adams
Jefferson
Fulton
Dauphin
Beaver
Armstrong
Montgomery
Lawrence
Tioga
Erie
PotterBradfordMcKeanWarren
Wayne
Crawford
Mercer
Westmoreland
Forest
Susquehanna
Mifflin
Sullivan
Juniata
Columbia
Union
Carbon
LehighSnyder
Cumberland
Cameron
Wyoming
Lebanon
Lackawanna
Northumberland
Northampton
Delaware
Montour
Philadelphia
Percent Staging* of Colon Cancer Cases, By CountyWhere Lymph Nodes Were Examined Following Surgery
Pennsylvania Cancer Registry Data (2004 - 2005)
SOURCE: Pennsylvania Department of Health, Bureau of Health Statistics and Research, Pennsylvania Cancer Registry, October, 2007
* AJCC Staging Definition
We can also examine stage comparisons by county, albeit
some counties have very small overall numbers
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Elk1828
York112266
Centre1651
Berks142372
Lycoming4683
Bedford1628
Butler75136
Clearfield4468
Clinton1017
Pike922
Somerset3461
Luzerne142316
Indiana3452
Fayette88130
Lancaster179330
Blair70121
Chester120280
Mercer6295
Perry1830
Franklin5294
Bucks205404
Cambria79159
Clarion314
Schuylkill85129
Monroe4390
Huntingdon2030
Venango3046
Greene2229
Westmoreland216392
Allegheny6011087
Washington135190
Adams5169
Jefferson2743
Dauphin110171
Fulton56
Armstrong3765
Beaver63171
Columbia2845
Carbon2648
Union1826
Cumberland59104
Snyder1830
Lebanon4387
Lawrence5475
Tioga1433
Erie80164
Potter45
Bradford3045
Warren1828
McKean2138
Crawford2955
Wayne2948
Forest24
Susquehanna1940
Mifflin3446
Sullivan14
Juniata1316
Lehigh103227
Cameron13
Wyoming1526
Montgomery247521
Lackawanna131234
Northumberland4468
Northampton93222
Delaware217457
Montour1330
Philadelphia5161029
Percent of Colon Cancer Cases With Less Than 12 Nodes ExaminedPennsylvania Cancer Registry Data (2004 - 2005)
Percent
00.0% - 35% 35.1% - 45% 45.1% - 55% 55.1% - 65% 65.1% - 75% 75.1% - 100%
NOTE: The top number under the county name represents the number of stage 0, I, II, and III (AJCC Staging definition) colon cancer cases where less than 12 lymph nodes were examined. The bottom number represents the total number of colon cancer cases with lymph nodes being examined by a pathologist. The color shading and percentages are based on the ratio of the two numbers in each county.
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TiogaPotter
Pike
Clinton
Warren
Perry
Elk1118
Clarion
Huntingdon
York54140
Erie60
107
Forest
Centre1132
Berks54179
Sullivan
Juniata
Lycoming2245
Union
Bradford1725
Bedford1118
Butler4075
Somerset1938
Clearfield2842
Snyder
McKean1117
Cameron
Luzerne61157
Wayne2031
Crawford1731
Fayette4871
Indiana2028
Lancaster95181
Bucks103229
Blair4063
Chester66177
Mercer3248
Franklin3259
Venango1726
Schuylkill3862
Greene1319
Monroe2956
Cambria3476
Allegheny335619
Westmoreland104215Washington
6799
Adams2736
Jefferson1120
Susquehanna1223
Dauphin5487
Beaver2584
Armstrong2237
Wyoming1018
Lawrence3752
Fulton
Mifflin2532
Columbia1830 Carbon
1021
Lehigh54
133
Cumberland3658
Lebanon2551
Montgomery127276
Montour
Lackawanna69126
Northumberland2538
Northampton36124
Delaware141282
Philadelphia261554
Percent of Stage I And Stage II Colon Cancer CasesWith Less Than 12 Lymph Nodes Cumulatively Examined
Pennsylvania Cancer Registry Data (2004 - 2005)
Percent
0 - 40.0 40.1 - 55.0 55.1 - 65.0 65.1 - 100 Statistically Unreliable - Less Than 10 Cases
SOURCE: Pennsylvania Department of Health, Bureau of Health Statistics and Research, Pennsylvania Cancer Registry; October, 2007
NOTES: The top number under the county name is the number of stage I and stage II (AJCC Staging definition) colon cancer cases where less than 12 lymph nodes were examined following surgery. The bottom number is the total number of stage I and stage II colon cancer cases with lymph nodes being examined by a pathologist following surgery. The percentages are based on the ratio of the two numbers in each county where there were at least 10 cases with less than 12 lymph nodes being examined following surgery. County names/numbers that appear in red indicate significantly higher rates than the PA rate. Blue county names/numbers indicate significantly lower rates.
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Elk
Centre
BedfordSomerset
Pike
Clinton
Indiana
Perry
Greene
Clarion
Huntingdon
Jefferson
York3090
Erie2761
Fulton
Sullivan
Juniata
Lycoming1636
Columbia
UnionCarbon
Bradford1522
Snyder
Luzerne2592
Crawford1020
Fayette2545
Lancaster48108
Chester37111
Franklin2042
Venango1320
Westmoreland50129
Washington3250
Adams1017
TiogaPotter
McKeanWarren
Wayne
Forest
Susquehanna
Berks2098
Butler1943
Clearfield2029
Cameron
Wyoming
Bucks55135
Blair2440
Mercer2236
Schuylkill1837
Monroe1533
Cambria1446
Allegheny177378
Dauphin2648
Beaver1448
Armstrong1425
Mifflin1016
Lehigh2270
Cumberland1631
Lebanon1031
Montgomery69
177
Lawrence2031
Montour
Lackawanna3671
Northumberland1425
Northampton2082
Delaware77
174
Philadelphia134328
Percent of Stage I And Stage II Right* Colon Cancer CasesWith Less Than 12 Lymph Nodes Cumulatively Examined
Pennsylvania Cancer Registry Data (2004 - 2005)
Percent
0 - 40.0 40.1 - 55.0 55.1 - 65.0 65.1 - 100 Statistically Unreliable - Less Than 10 Cases
SOURCE: Pennsylvania Department of Health, Bureau of Health Statistics and Research, Pennsylvania Cancer Registry; October, 2007
NOTES: The top number under the county name is the number of stage I and stage II (AJCC Staging definition) right colon cancer cases where less than 12 lymph nodes were examined following surgery. The bottom number is the total number of right colon cancer cases with lymph nodes being examined by a pathologist following surgery. The percentages are based on the ratio of the two numbers in each county where there were at least 10 cases with less than 12 lymph nodes being examined following surgery. County names/numbers that appear in red indicate significantly higher rates than the PA rate. Blue county names/numbers indicate significantly lower rates.
* Right colon cancer refers to ICD-O-3 sites C18.0 - C18.4
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Elk
Centre
Lycoming
BedfordSomerset
Pike
Clinton
Clearfield
Perry
MercerVenango
Greene
Clarion
Huntingdon
Jefferson
York2449
Erie3243
Fulton
Armstrong
Sullivan
Juniata
Columbia
UnionCarbon
Snyder
Luzerne3463
Wayne1113
Fayette2123
Lancaster4670
Chester2964
Franklin1116
Westmoreland5485
Washington3546
Adams1618
TiogaPotter
BradfordMcKeanWarren
Crawford
Forest
Susquehanna
Berks3174
Butler2029
Cameron
Wyoming
Indiana1214
Bucks4588
Blair1522
Schuylkill1924
Monroe1322
Cambria1929
Allegheny144222
Dauphin2736
Beaver1135
Mifflin1516
Lehigh3059
Cumberland2027
Lebanon1217
Montgomery5693
Lawrence1619
Montour
Lackawanna3354
Northumberland1113
Northampton1640
Delaware61
103
Philadelphia121210
Percent of Stage I And Stage II Left* Colon Cancer CasesWith Less Than 12 Lymph Nodes Cumulatively Examined
Pennsylvania Cancer Registry Data (2004 - 2005)
Percent
0 - 40.0 40.1 - 55.0 55.1 - 65.0 65.1 - 100 Statistically Unreliable - Less Than 10 Cases
SOURCE: Pennsylvania Department of Health, Bureau of Health Statistics and Research, Pennsylvania Cancer Registry; October, 2007
NOTES: The top number under the county name is the number of stage I and stage II (AJCC Staging definition) left colon cancer cases where less than 12 lymph nodes were examined following surgery. The bottom number is the total number of left colon cancer cases with lymph nodes being examined by a pathologist following surgery. The percentages are based on the ratio of the two numbers in each county where there were at least 10 cases with less than 12 lymph nodes being examined following surgery. County names/numbers that appear in red indicate significantly higher rates than the PA rate. Blue county names/numbers indicate significantly lower rates.
* Left colon cancer refers to ICD-O-3 sites C18.5 - C18.7
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Data Quality ConcernsData Quality Concerns Chemotherapy Admin for Stage III
CS was new effective 2004; AJCC Stage Group derived for these cases – level of review?
Collection of treatment data started in ~2000 for non-ACOS COC hospitals reporting to the PCR, this is the first time they are looking at treatment specific benchmark.
Documentation of chemotherapy administration for many community facilities may be lacking – level of review / follow back?
Documentation of recommendation/administration in any “hospital-based” record is of concern. With chemo being administered in outpatient environments, UPMC has an optimal environment to assist with evaluation.
Regional LN Removal “It is what it is” – a reflection of surgical removal, pathologic
findings and registrar documentation Data evaluation process now underway – UPMC involved
with modeling project PCR staff evaluating how PA registrars document
chemotherapy administration
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How are we doing? How are we doing? 2006 data2006 dataFacility Col1:
Chemo for Stage III
Col1: PCRAllegheny
County(2004-2005)
Col2: >=12 RLN removed
Col2: PCRAllegheny
County(2004-2005)
Hosp BVery small community based; low socioeconomic area
1/520%
50-75%(% having
chemo admin for Stage III)
2/1216.7%
35-45%(% having 12 or more LN removed)
Hosp PMid sized community based; high socioeconomic area
9/1275%
15/4037.5%
Hosp S1Teaching hospital; mixed SE
66/8479%
122/17171%
Hosp S2small urban facility
3/560%
8/1650%
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Discussion PointsDiscussion Points Familiarize yourself with the indicators Data Sources
Cancer registry – public health reporting Pathology – synoptics, diagnosis, staging Radiology Pharmacy Labs – screening, recurrence
Issues with standards and measurable criteria
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ReferencesReferences www.cms.hhs.gov/apps/media/press/release.asp?Counter=1343 http://www.kff.org/insurance/7031/print-sec1.cfm http://outcomes.cancer.gov/survey/test_report http://www.ahrq.gov/qual/nhqr07/Chap2.htm#cancer http://www.qualitymeasures.ahrq.gov/ http://www.qualityforum.org/ www.nccn.org http://www.nccn.org/professionals/physician_gls/f_guidelines.asp http://www.guideline.gov/ www.facs.org/cancer/qualitymeasures.html www.facs.org/cancer/coc/ncdboverview.html www.pac3.org http://www.ncqa.org/ http://www.qipa.org/pa/ http://www.paehi.org/ http://www.prhi.org/