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

Casefinding Systematic process to identify all cases eligible to be included in the registry database Systematic process to identify all cases eligible to be included in the registry database Includes both inpatients and outpatients Includes both inpatients and outpatients Required at all types of facilities Required at all types of facilities Need an up to date Reportable List Need an up to date Reportable List

Reportable List Include all malignancies (carcinomas, sarcomas, melanoma, leukemia, lymphomas Include all malignancies (carcinomas, sarcomas, melanoma, leukemia, lymphomas Benign brain tumors (must be reported as of 1/1/2004) Benign brain tumors (must be reported as of 1/1/2004) Cases reportable by agreement (ACOS hospital cancer programs) Cases reportable by agreement (ACOS hospital cancer programs)

What Should be Reported in Mississippi? Analytic cases diagnosed on or after January 1, 1996 Analytic cases diagnosed on or after January 1, 1996 Cases that were diagnosed and/or treated at your facility (on or after 1/1/96) Cases that were diagnosed and/or treated at your facility (on or after 1/1/96) Pathology only cases read by pathologists must be reported Pathology only cases read by pathologists must be reported Nonanalytic cases – submit when requested by MCR Nonanalytic cases – submit when requested by MCR

Additional Cases to Report Squamous intraepithelial neoplasia grade III of the following: Squamous intraepithelial neoplasia grade III of the following: –Vulva (VIN) –Vagina (VAIN) –Anus (AIN) Refer to the state reportable list Refer to the state reportable list

Mississippi - Do Not Report History of Cancer Cases History of Cancer Cases Basal cell and squamous cell carcinomas of the skin Basal cell and squamous cell carcinomas of the skin

Types of Casefinding Active casefinding Active casefinding –More thorough –More accurate –Costs more Passive casefinding Passive casefinding –Self reporting less reliable –Dependent on others to ID cases –More likely to miss cases

Casefinding Sources Methods vary by individual facility Methods vary by individual facility Depends on services offered at facility Depends on services offered at facility Multiple sources needed to identify all cases Multiple sources needed to identify all cases

Casefinding Sources Continued Pathology, cytology reports Pathology, cytology reports Admission/discharge documents Admission/discharge documents Disease indices/coding reports Disease indices/coding reports Surgery schedule Surgery schedule Nuclear medicine logs Nuclear medicine logs Radiation treatment logs Radiation treatment logs

Casefinding Sources Continued Hematology or Oncology clinic appointment schedules Hematology or Oncology clinic appointment schedules Bone marrow reports Bone marrow reports Mammography reports Mammography reports CT/MRI reports CT/MRI reports Autopsy reports Autopsy reports

Pathology & Cytology Reports >90% of cases >90% of cases Review copies reports Review copies reports Computer generated listing – specify codes Computer generated listing – specify codes Outside cases reviewed by pathologist Outside cases reviewed by pathologist

Admission/Discharge Documents Daily or weekly review Daily or weekly review Can be done at time discharge records processed Can be done at time discharge records processed May be a computer generated list of patients May be a computer generated list of patients

Admission/Discharge List Name MR # Serv DcDate ICD-9 Code L name, 7777 Med First Sort according to your specifications Sort according to your specifications

Disease Indices/Coding Reports Run monthly, depending on case load Run monthly, depending on case load May be hard copy or electronic May be hard copy or electronic Based on cases coded Based on cases coded Obtain from health information management/medical record department Obtain from health information management/medical record department

Disease Index – October 2005 Name MR# DCDate PrimDx SecDx Jones R /15/ May S /18/05 V Wade W /09/05 185

Surgery Schedule Surgery Schedule Type of procedure Type of procedure Examples Examples –Modified radical mastectomy –Radical prostatectomy Especially important for outpatient surgery centers Especially important for outpatient surgery centers

Nuclear Medicine Log Bone scans Bone scans I-131 treatment for thyroid cancer I-131 treatment for thyroid cancer

Radiation Treatment Logs Patients treated with radiation Patients treated with radiation Patient may have been diagnosed elsewhere Patient may have been diagnosed elsewhere Patients may be included with disease index/coding list (need to know how coding is handled at facility) Patients may be included with disease index/coding list (need to know how coding is handled at facility)

Hematology or Oncology Visits Hematology or Oncology clinic on site Hematology or Oncology clinic on site Patients may not be admitted to hospital Patients may not be admitted to hospital –Chronic lymphocytic leukemia –Polycythemia Vera Diagnosis by CBC or other blood test Diagnosis by CBC or other blood test

Bone Marrow Reports Report may be generated by pathology or hematologist Report may be generated by pathology or hematologist Leukemias, myeloproliferative disorders, other malignancies Leukemias, myeloproliferative disorders, other malignancies –Chronic lymphocytic leukemia –Refractory anemia –Lymphoma involving the bone marrow

Mammography Abnormal mammograms Abnormal mammograms Work with radiologists to identify cases that fit criteria for cancer diagnosis (i.e., compatible with, suspicious, probable for cancer – see reportable list) Work with radiologists to identify cases that fit criteria for cancer diagnosis (i.e., compatible with, suspicious, probable for cancer – see reportable list)

CT & MRI Reports Clinical diagnosis of cancer Clinical diagnosis of cancer Benign brain tumors Benign brain tumors –Pituitary adenoma –Meningioma Brain metastasis Brain metastasis Work with radiologists to identify cases that fit criteria for cancer diagnosis (i.e., compatible with, suspicious, probable for cancer – see reportable list) Work with radiologists to identify cases that fit criteria for cancer diagnosis (i.e., compatible with, suspicious, probable for cancer – see reportable list)

Autopsy Report May confirm primary site (unknown primary) May confirm primary site (unknown primary) New cancer not diagnoses previously may be identified New cancer not diagnoses previously may be identified –Prostate cancer, incidental finding

Casefinding – State Registry Hospitals Hospitals Independent Pathology Laboratories Independent Pathology Laboratories Freestanding Radiation Facilities Freestanding Radiation Facilities Physician Offices Physician Offices –Hematology/Oncology –Dermatology –Urologist –Neurologist –Radiologist

Casefinding – State Registry Outpatient Surgery Center, freestanding Outpatient Surgery Center, freestanding Hospice Hospice Nursing Homes Nursing Homes Death Certificates Death Certificates Others? Others?

Review/Link Identified Cases Compare site in registry database – new versus prior malignancy Compare site in registry database – new versus prior malignancy Identify subsequent malignancies Identify subsequent malignancies

Enter Patient in Suspense File Cases that are potentially reportable Cases that are potentially reportable Cases that need to be abstracted Cases that need to be abstracted Include - Name, Identifier, Date of first contact/Diagnosis Date, Primary site Include - Name, Identifier, Date of first contact/Diagnosis Date, Primary site File/sort by date identified File/sort by date identified

Monitor Casefinding Completeness Quality control function Quality control function Maintain a casefinding log Maintain a casefinding log Review number of cases by month Review number of cases by month Review number of cases by casefinding source Review number of cases by casefinding source Look at primary site totals Look at primary site totals

Casefinding Audits Completed by State Registry or other entities Completed by State Registry or other entities Assess completeness of casefinding Assess completeness of casefinding

Summary Casefinding is an important procedure to identify cases Casefinding is an important procedure to identify cases Identify facility specific methods to identify cases Identify facility specific methods to identify cases Monitor casefinding for quality control Monitor casefinding for quality control