NPCR Data Completeness and Quality Audits Review of Collaborative Stage and Surgery Data

1. NPCR Data Completeness and Quality AuditsReview of:Collaborative Stage and Surgery DataMary Lewis, CTRNPCR Program Consultant

2. Objectives: • Assess quality of: • Collaborative Stage • Derived Summary Stage • Surgery Data • Identify data resources • Summarize solutions • Training Issues • Improvement of processes

3. Breast Colon Rectum Lung Prostate Melanoma Gynecologic Other Digestive Sites Stomach Pancreas Liver Small Intestine Evaluation of:

4. Stage of Disease Error RateAll Sites % Errors Collaborative Stage Data Elements

5. Stage of Disease Error RatesDigestive Primaries %Errors Collaborative Stage Data Elements

6. CS Errors – Colo-rectal • Derived Summary Stage 2000:(9.8%/7.3) • Overall impact - 9% in Digestive Primaries • Due to changes is CS data fields: • Unknown to Known • Is situ to Invasive • Additional surgery, scans, workup • Lack of supporting documentation

7. Stage of Disease Error RatesRespiratory Primaries

8. CS Errors - Lung • Derived Summary Stage 2000: 8.8%/12.9% • Overall impact- 11% in Lung Primaries • Changes in CS fields: • Consolidation of Data • Additional Surgery, scans, work-up • Physician Documentation • Lack of supporting documentation

9. Stage of Disease Error Rates Breast Primaries % Errors

10. CS Errors - Breast • Derived Summary Stage 2000: (2.5%/6.1%) • Overall impact was 4% in Breast Primaries • Changes in CS fields: • Lack of supporting documentation • Information from physical exam • Unknown vs Known • Rules re: in-situ tumor

11. Stage of Disease Error Rates Prostate Primaries % Errors Collaborative Stage Data Elements

12. CS Errors - Prostate • Derived Summary Stage 2000: (5%/5%) • Overall impact–5% in Prostate Primaries • Due to changes in CS fields • Physical Exam • Unknown to Known • Documentation • Additional scans, work-up

13. Other Digestive Sites - Pancreas • CS Extent of Disease: • Known vs. Unknown 10 – Confined to tail vs. 99 – No information • Documentation, CT Scans 60 – Mesenteric artery vs. 50 - Vessels, NOS 63 – Liver vs. 30 – Localized, NOS 3-Regional vs. 1-Localized

14. Other Digestive Sites - Stomach • CS Extent of Disease: • No Supporting Documentation 60 – Liver, Pancreas vs. 30 – Localized, NOS 3-Regional vs. 1-Localized • Pathology Documentation 40 – Through Wall, NOS vs. 45 – Perigastric Fat 50 – Through Serosa vs. 45 – Gastric Artery

15. Other Digestive Sites - Liver • CS Extent of Disease: • No Information vs. Localized 99 – Unknown vs. 50 – Confined to Liver 9-Unknown vs. 1-Localized • Specific Information: 65 – Liver Nodules vs. 80 - Pancreas 2-Regional vs. 7 - Distant

16. Skin: Melanoma • CS Extent of Disease: • Specific Information: 50 – Clark’s Level V vs. 10 – Clark’s Level IV 40 – Local, NOS vs. 10 – Clark’s Level I 1 – Local vs. O – In situ

17. Gynecologic Sites - Ovary Specific Information • CS Extent of Disease: 99 – Unknown vs. 72 – Stage IIIC 30 – Local, NOS vs. 00 – Neg Nodes Per Pathology Report 99 – Unknown vs. 00 – Neg PET Scan

18. Gynecologic Sites - Uterus Specific Information • CS Extent of Disease: 50 – FIGO II (NOS) vs. 12 – 1/3 Myometrium 2 – Regional vs. 1 - Localized 99 – Unknown vs. 00 – Non-invasive 12 – Stage IB vs. 40 – Local, NOS

19. Brain/Cerebral Meninges Specific Information • CS Extent of Disease: 10 – One Side vs. 40 – Crosses Midline 1 – Localized vs. 2 – Regional

20. Surgery Data Data Fields: 1. Surgery Date 2. Surgery of Primary Site 3. Regional Lymph Node Surgery 4. Surgery Other Regional/Distant Site

21. Surgery Data Surgery Date • Evaluates date of first surgery for: • Primary Site • Regional Lymph Nodes • Other Regional/Distant Sites • Doesn’t always coincide with most definitive Surgery • Error Rate – 5%

22. Surgery Data Surgery Date • None vs. Known Date 00/00/0000 vs. 07/01/05 • Doesn’t Agree With Surgery Code 7/1 – Exc Mass; 7/7 – Wide Re-excision • Applies to ALL Surgery Fields 7/1 – Exc Brain Mets; 7/7 – Primary Site Resection

23. Surgery Data Surgery of Primary Site • Rx Summ Surg Prim Site –Item 1290 • Error Rate– Yr 1 – 10.3% Yr 2 – 12.3% • Highest Errors in: • Breast • Colon • Urinary Bladder

24. Surgery Data Surgery of Primary Site – Continued Issues • 00 vs. Known Code • NOS vs. Specifics Breast: Specifics re: Mastectomy 41 – Simple vs. 50 Modified Radical (MRM) Colon:27 – Excision Bx vs. 28 – Polypectomy Bladder:20 – Excision, NOS vs. 27 Excisional Bx vs. 22 – Combination 20 or 27 With Electrocautery • Consolidation of Data • 20-Lumpectomy vs. 40 - Mastectomy

25. Surgery Data Regional Lymph Node Surgery • Rx Summ Scope Reg LN • Item 1292 • Error Rate – Yr 1–5.7%; Yr 2–6.8% Issues: • Cumulative • Combination Code

26. Surgery Data Other Regional/Distant Surgery • Rx Summ Surg Oth Reg/Dis • Item 1294 • Error Rate – Yr 1–2.6%; Yr 2–2.3% Issues: Unknown vs. Known 99 vs. 00 – Early Stage Disease

27. Summary • To increase accuracy in: • Collaborative Stage of Disease • Summary Stage 2000 • Surgery Data • Methods: • Training • Consolidation Rules • Method to update

28. Mary Lewis, CTR MLewis2@cdc.gov 770-488-4827 http://www.cdc.gov/cancer.npcr/index.htm The findings and conclusions in this report are those of the author and do not necessarily represent the official position of the Centers for Disease Control and Prevention