CASEFINDING Debra W. Christie, MBA, RHIA, CTR, CCRP Director, Cancer Research & Data Center University of Mississippi Medical Center.

CASEFINDINGCASEFINDING

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

Director, Cancer Research & Data Director, Cancer Research & Data CenterCenter

University of Mississippi Medical University of Mississippi Medical CenterCenter

CasefindingCasefinding

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

• Includes both inpatients and Includes both inpatients and outpatients 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 Benign brain tumors (must be reported as of 1/1/2004)reported as of 1/1/2004)

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

What Should be Reported What Should be Reported in Mississippi?in Mississippi?

• Analytic cases diagnosed on or after Analytic cases diagnosed on or after January 1, 1996January 1, 1996

• Cases that were diagnosed and/or Cases that were diagnosed and/or treated at your facility (on or after treated at your facility (on or after 1/1/96)1/1/96)

• Pathology only cases read by Pathology only cases read by pathologists must be reportedpathologists must be reported

• Nonanalytic cases – submit when Nonanalytic cases – submit when requested by MCRrequested by MCR

Additional Cases to Additional Cases to ReportReport

• Squamous intraepithelial neoplasia Squamous intraepithelial neoplasia grade III of the following:grade 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 Basal cell and squamous cell carcinomas of the skincarcinomas of 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 Depends on services offered at facilityfacility

• Multiple sources needed to identify Multiple sources needed to identify all casesall cases

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 Pathology & Cytology ReportsReports

• >90% of cases>90% of cases

• Review copies reportsReview copies reports

• Computer generated listing – specify Computer generated listing – specify codescodes

• Outside cases reviewed by Outside cases reviewed by pathologist pathologist

Admission/Discharge Admission/Discharge DocumentsDocuments

• Daily or weekly reviewDaily or weekly review

• Can be done at time discharge Can be done at time discharge records processedrecords processed

• 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 9-1-05 174.9

FirstFirst

• 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 management/medical record departmentdepartment

Disease Index – October Disease Index – October 20052005

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 Especially important for outpatient surgery centerssurgery centers

Nuclear Medicine LogNuclear Medicine Log

• Bone scansBone scans

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

Radiation Treatment Radiation Treatment LogsLogs• 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 Patients may not be admitted to hospitalhospital– 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 Report may be generated by pathology or hematologistpathology or hematologist

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

Autopsy ReportAutopsy Report

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

• New cancer not diagnoses previously New cancer not diagnoses previously may be identifiedmay be 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, Outpatient Surgery Center, freestandingfreestanding

• HospiceHospice

• Nursing HomesNursing Homes

• Death CertificatesDeath Certificates

• Others?Others?

Review/Link Identified Review/Link Identified CasesCases

• Compare site in registry database – Compare site in registry database – new versus prior malignancynew versus 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 Review number of cases by casefinding sourcecasefinding source

• 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 Casefinding is an important procedure to identify casesto identify cases

• Identify facility specific methods to Identify facility specific methods to identify casesidentify cases

• Monitor casefinding for quality controlMonitor casefinding for quality control