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  1. 1. CASEFINDINGCASEFINDING Debra W. Christie, MBA, RHIA, CTR,Debra W. Christie, MBA, RHIA, CTR, CCRPCCRP Director, Cancer Research & Data CenterDirector, Cancer Research & Data Center University of Mississippi Medical CenterUniversity of Mississippi Medical Center
  2. 2. CasefindingCasefinding • Systematic process to identify all casesSystematic process to identify all cases eligible to be included in the registryeligible to be included in the registry databasedatabase • Includes both inpatients and outpatientsIncludes both inpatients and 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
  3. 3. Reportable ListReportable List • Include all malignancies (carcinomas,Include all malignancies (carcinomas, sarcomas, melanoma, leukemia,sarcomas, melanoma, leukemia, lymphomaslymphomas • Benign brain tumors (must be reported asBenign brain tumors (must be reported as of 1/1/2004)of 1/1/2004) • Cases reportable by agreement (ACOSCases reportable by agreement (ACOS hospital cancer programs)hospital cancer programs)
  4. 4. What Should be Reported inWhat Should be Reported in Mississippi?Mississippi? • Analytic cases diagnosed on or afterAnalytic cases diagnosed on or after January 1, 1996January 1, 1996 • Cases that were diagnosed and/or treatedCases that were diagnosed and/or treated at your facility (on or after 1/1/96)at your facility (on or after 1/1/96) • Pathology only cases read by pathologistsPathology only cases read by pathologists must be reportedmust be reported • Nonanalytic cases – submit whenNonanalytic cases – submit when requested by MCRrequested by MCR
  5. 5. Additional Cases to ReportAdditional Cases to Report • Squamous intraepithelial neoplasia gradeSquamous intraepithelial neoplasia grade III of the following: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
  6. 6. Mississippi - Do NotMississippi - Do Not ReportReport • History of Cancer CasesHistory of Cancer Cases • Basal cell and squamous cell carcinomasBasal cell and squamous cell carcinomas of the skinof the skin
  7. 7. 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
  8. 8. Casefinding SourcesCasefinding Sources • Methods vary by individual facilityMethods vary by individual facility • Depends on services offered at facilityDepends on services offered at facility • Multiple sources needed to identify allMultiple sources needed to identify all casescases
  9. 9. Casefinding SourcesCasefinding 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
  10. 10. Casefinding SourcesCasefinding Sources ContinuedContinued • Hematology or Oncology clinicHematology or Oncology clinic appointment schedulesappointment schedules • Bone marrow reportsBone marrow reports • Mammography reportsMammography reports • CT/MRI reportsCT/MRI reports • Autopsy reportsAutopsy reports
  11. 11. Pathology & Cytology ReportsPathology & Cytology Reports • >90% of cases>90% of cases • Review copies reportsReview copies reports • Computer generated listing – specifyComputer generated listing – specify codescodes • Outside cases reviewed by pathologistOutside cases reviewed by pathologist
  12. 12. Admission/DischargeAdmission/Discharge DocumentsDocuments • Daily or weekly reviewDaily or weekly review • Can be done at time discharge recordsCan be done at time discharge records processedprocessed • May be a computer generated list ofMay be a computer generated list of patientspatients
  13. 13. Admission/Discharge ListAdmission/Discharge List NameName MR #MR # ServServ DcDateDcDate ICD-9ICD-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
  14. 14. Disease Indices/CodingDisease Indices/Coding ReportsReports • 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 informationObtain from health information management/medical record departmentmanagement/medical record department
  15. 15. Disease Index – October 2005Disease Index – October 2005 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
  16. 16. Surgery ScheduleSurgery Schedule • Type of procedureType of procedure • ExamplesExamples – Modified radical mastectomyModified radical mastectomy – Radical prostatectomyRadical prostatectomy • Especially important for outpatient surgeryEspecially important for outpatient surgery centerscenters
  17. 17. Nuclear Medicine LogNuclear Medicine Log • Bone scansBone scans • I-131 treatment for thyroid cancerI-131 treatment for thyroid cancer
  18. 18. Radiation Treatment LogsRadiation Treatment Logs • Patients treated with radiationPatients treated with radiation • Patient may have been diagnosedPatient may have been diagnosed elsewhereelsewhere • Patients may be included with diseasePatients may be included with disease index/coding list (need to know howindex/coding list (need to know how coding is handled at facility)coding is handled at facility)
  19. 19. Hematology or OncologyHematology or Oncology VisitsVisits • Hematology or Oncology clinic on siteHematology or Oncology clinic on site • Patients may not be admitted to hospitalPatients may not be admitted to hospital – Chronic lymphocytic leukemiaChronic lymphocytic leukemia – Polycythemia VeraPolycythemia Vera • Diagnosis by CBC or other blood testDiagnosis by CBC or other blood test
  20. 20. Bone Marrow ReportsBone Marrow Reports • Report may be generated by pathology orReport may be generated by pathology or hematologisthematologist • Leukemias, myeloproliferative disorders,Leukemias, myeloproliferative disorders, other malignanciesother malignancies – Chronic lymphocytic leukemiaChronic lymphocytic leukemia – Refractory anemiaRefractory anemia – Lymphoma involving the bone marrowLymphoma involving the bone marrow
  21. 21. MammographyMammography • Abnormal mammogramsAbnormal mammograms • Work with radiologists to identify casesWork 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 forcompatible with, suspicious, probable for cancer – see reportable list)cancer – see reportable list)
  22. 22. 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 that fitWork with radiologists to identify cases that fit criteria for cancer diagnosis (i.e., compatiblecriteria for cancer diagnosis (i.e., compatible with, suspicious, probable for cancer – seewith, suspicious, probable for cancer – see reportable list)reportable list)
  23. 23. Autopsy ReportAutopsy Report • May confirm primary site (unknownMay confirm primary site (unknown primary)primary) • New cancer not diagnoses previously mayNew cancer not diagnoses previously may be identifiedbe identified – Prostate cancer, incidental findingProstate cancer, incidental finding
  24. 24. Casefinding – StateCasefinding – State RegistryRegistry • HospitalsHospitals • Independent Pathology LaboratoriesIndependent Pathology Laboratories • Freestanding Radiation FacilitiesFreestanding Radiation Facilities • Physician OfficesPhysician Offices – Hematology/OncologyHematology/Oncology – DermatologyDermatology – UrologistUrologist – NeurologistNeurologist – RadiologistRadiologist
  25. 25. Casefinding – StateCasefinding – State RegistryRegistry • Outpatient Surgery Center, freestandingOutpatient Surgery Center, freestanding • HospiceHospice • Nursing HomesNursing Homes • Death CertificatesDeath Certificates • Others?Others?
  26. 26. Review/Link IdentifiedReview/Link Identified CasesCases • Compare site in registry database – newCompare site in registry database – new versus prior malignancyversus prior malignancy • Identify subsequent malignanciesIdentify subsequent malignancies
  27. 27. Enter Patient in SuspenseEnter 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 firstInclude - Name, Identifier, Date of first contact/Diagnosis Date, Primary sitecontact/Diagnosis Date, Primary site • File/sort by date identifiedFile/sort by date identified
  28. 28. Monitor CasefindingMonitor 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 casefindingReview number of cases by casefinding sourcesource • Look at primary site totalsLook at primary site totals
  29. 29. Casefinding AuditsCasefinding Audits • Completed by State Registry or otherCompleted by State Registry or other entitiesentities • Assess completeness of casefindingAssess completeness of casefinding
  30. 30. SummarySummary • Casefinding is an important procedure toCasefinding is an important procedure to identify casesidentify cases • Identify facility specific methods to identifyIdentify facility specific methods to identify casescases • Monitor casefinding for quality controlMonitor casefinding for quality control
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