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!
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