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Casefinding & Follow-Up

Casefinding & Follow-Up. Dolores E. McCord, RHIT, CTR Piedmont Hospital Atlanta, Georgia. Follow-Up and Casefinding. Inter-related Procedures Casefinding leads to follow-up Follow-up leads to casefinding. Casefinding – Sources. No casefinding, no registry Pathology Department – a MUST

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Casefinding & Follow-Up

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  1. Casefinding & Follow-Up Dolores E. McCord, RHIT, CTR Piedmont Hospital Atlanta, Georgia

  2. Follow-Up and Casefinding • Inter-related Procedures • Casefinding leads to follow-up • Follow-up leads to casefinding 2004 GATRA Educational Conference

  3. Casefinding – Sources • No casefinding, no registry • Pathology Department – a MUST • Surgical reports • Hospital patient • Physician office • Path only • Cytology • Bone marrows • Autopsy Reports 2004 GATRA Educational Conference

  4. Casefinding – Sources • No casefinding, no registry • Medical Record Indices – a MUST • Outpatient Departments • Radiation Therapy • Infusion Therapy / Chemotherapy • Others? 2004 GATRA Educational Conference

  5. Casefinding • Multiple sources – to find • Nothing • New patient, new diagnosis • Existing patient, new diagnosis, follow-up of existing diagnosis • Existing patient, existing diagnosis, recurrent or progression, follow-up • Existing patient, existing diagnosis, no change, follow-up 2004 GATRA Educational Conference

  6. Casefinding • History of, existing cases – trouble-makers • Why patient in hospital system with cancer codes? • What if the biopsy was negative? What were they trying to find? • Ruling out presence of cancer? • Trying to confirm presence of cancer, suspected? • What about x-rays, scans? What are they looking for? • Bigger question: How far do you go? 2004 GATRA Educational Conference

  7. Follow-Up • The reason the hospital registry exists. • Finds recurrences and new primaries for existing patients • Requires resources, time, and diligence. • Provides the real value for registry: patient outcome. 2004 GATRA Educational Conference

  8. Follow-Up • Is the patient still alive? • Simple question – answered, • Yes • No. • The patient is dead – end of story? • ICD Cause of Death: to code or not to code. That is the question. 2004 GATRA Educational Conference

  9. Follow-Up • Is the cancer present, or was present at last contact/death? • Not so simple. • Never Disease-Free Cancers: Unknown Primaries, distant metastases at diagnosis. • Can the cancer go away? • Is the patient clinically without evidence of disease – per physician? • Recurrent Cancers: did treatment eradicate all cancer? 2004 GATRA Educational Conference

  10. Follow-Up • Cancer status: 1, 2, or 9? • Last follow-up, cancer status: 1 • Next follow-up, cancer status: 1? • Any evidence for recurrence? • Questionable status – rising markers, uncertainty 2004 GATRA Educational Conference

  11. Follow-Up • Cancer status: 1, 2, or 9? • Last follow-up, cancer status: 2 • Next follow-up, cancer status: 2? • Did treatment eradicate all evidence of cancer? • Where did it go? 2004 GATRA Educational Conference

  12. Follow-Up • Cancer status 1, 2, or 9? • Last follow-up, cancer status: 9 • Next follow-up, cancer status: __? 2004 GATRA Educational Conference

  13. Follow-Up • COC Requirements • Patient status • Cancer status • Recurrence information 2004 GATRA Educational Conference

  14. Follow-Up • Not Required by COC • Subsequent treatment • Specific metastatic site(s) 2004 GATRA Educational Conference

  15. Follow-Up • Subsequent treatment – completes the picture • Recurrences – what happened next? • Non-analytic cases – was cancer care given? • Biopsy? More surgery? Radiation? Chemotherapy? Palliative care? • Administrative reports – radiation, 1st or 2nd course – a must! 2004 GATRA Educational Conference

  16. Follow-Up • Recurrence information – Metastatic Sites • Single site, specific code • Multiple sites, combination code – lose information • Brain mets, at DX and at recurrence – administrative reports 2004 GATRA Educational Conference

  17. Follow-Up Process • Steps = Success • List due for follow-up • Hospital system: inpatients, outpatients, ED • MQS • SSDI • Other? 2004 GATRA Educational Conference

  18. Follow-Up Process • Steps = Success • Letters • Physicians: one vs. all • Patients • Other physicians? • Secondary contacts? • Last resorts – the phone 2004 GATRA Educational Conference

  19. Follow-Up Letters • Patient Letters • Valuable information • New doctors • New address • Date of last contact – post mark date • Returned – Pain in the ____! • MLNA – address search • New address 2004 GATRA Educational Conference

  20. Follow-Up Letters • Physician Letters • Not always reliable • Wrong dates, unknown info • Source for other physicians • Recurrence and subsequent treatment information • Clinical trial inclusion • Keep physician contacts updated 2004 GATRA Educational Conference

  21. Follow-Up Letters • Other Contact Letters • Rarely used • Varied response rates • Could be useful 2004 GATRA Educational Conference

  22. Follow-Up Sources • Letters / Phone calls • Admissions / hospital service (CF) • Path reports (CF) • Clinic / outpatient visits (CF) • Internet sources • Death certificates • Obits 2004 GATRA Educational Conference

  23. Follow-Up Rates • Two Measurements • Since reference date: 80% • Diagnosed last 5 years: 90% • No longer 80% of alive analytic patients • No longer 90% of all analytic patients 2004 GATRA Educational Conference

  24. Follow-Up Rates • Who are not followed? • Non-analytic cases • CIS, CIN III, other III’s • Previously collected localized skins • Benign / borderline tumors • Foreign residents • Reportable by agreement • >100 years old, last contact >12 months 2004 GATRA Educational Conference

  25. Follow-Up Rates • Who are lost? • “…delinquent if no contact has been made with the patient within fifteen months after the date of last contact.” • Hutchison, C.L., S.D. Roffers, and A.G. Fritz (eds.), Cancer registry management: principles and practice. Dubuque: Kendall/Hunt Publishing Company, 1997, p. 137. 2004 GATRA Educational Conference

  26. Follow-Up Rates • Who are lost? • Last Contact: June 2003 • 12 months: June 2004 • 13 months: July 2004 • 14 months: August 2004 • 15 months: September 2004 • Lost 16 months: October 2004 2004 GATRA Educational Conference

  27. Follow-Up Rates • Who are lost? • Current month: October 2004 • 12 months back: October 2003 • 13 months back: September 2003 • 14 months back: August 2003 • 15 months back: July 2003 • 16 months & lost: June 2003 & before 2004 GATRA Educational Conference

  28. Casefinding and Follow-Up • Made for each other! • One should always lead to the other. • Both time-consuming processes • Both basis for registry 2004 GATRA Educational Conference

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