Improving Hospital Reporting

Montana Central Tumor Registry

Delayed reporting from hospitals was causing the Montana Central Tumor Registry (MCTR) to not meet state or federal standards for reporting timeliness and completeness. After three years of receiving gold certification from the North American Association of Central Cancer Registries, our 2006 data received only silver certification, indicating that reporting was not 95% complete for diagnosis year 2006.

Montana has a small population of under a million people. Six American College of Surgeons (ACoS) hospitals report 75% of all Montana's cases and 90% of analytic cases. Of the 56 hospitals, five are considered large (reporting between 650 and 1,500 cases a year); eight are considered medium size (reporting between 100 and 450 cases a year); and the rest are small (reporting fewer than 100 cases each year). The medium and large facilities carry the weight for holding timeliness and completeness standards for Montana. Small facilities report so few cases that reporting in an untimely manner doesn’t impact the overall timeliness or completeness. Still, they are required to report all cases in a timely manner, and with the exception of a few small hospitals, most report cases routinely. Most small hospitals report cases on paper, with copies of relevant medical records. Smaller hospitals struggle with higher turnover rates than those of larger facilities. The MCTR consistently works with and trains new registrars who may not have a background in tumor registry activities.

Montana's cancer reporting law requires cancer cases to be reported within six months after diagnosis, and defines the types of cancers that are reportable and the required data fields. Unfortunately, there are no penalties for reporting cases late or not reporting at all. We needed to develop a positive way to encourage non-reporters to report, and help those who could not keep up-to-date with current reporting to report more timely.

We implemented—

• Delinquency letters for not reporting.
• Quarterly feedback reports to facilities.
• A certificate of excellence.
• Quarterly newsletters.
• Webinar training for new registrars via live Internet.
• An advisory group.
• The State of Montana File Transfer Service (FTP).

Hospitals that received a letter from the State of Montana indicating they were delinquent in reporting were quick to act. Hospitals that hadn't reported in the last year were required to submit a written plan of action to catch up reporting and begin reporting as soon as possible. Reporting old cases and getting current in reporting can be time-consuming, but hospitals hired extra staff or consultants to report. Timeliness of reporting is not yet all under six months of diagnosis, but when all facilities are current in reporting, timeliness will improve.

Quarterly feedback reports are sent to reporting facilities documenting reporting timeliness and reporting of unknown values on 10 data quality indicators: age, sex, race, county, payer, physical address, occupation, industry, tobacco history, and alcohol history. The reports help facilities keep track of their own reporting improvement and indicate where they still need to improve. In 2008, 29% of cases submitted to the MCTR were within six months of diagnosis, and this improved to 38% in 2010. Several hospitals are reporting old cases to catch up reporting backlog; the percentage reporting within six months is increasing slowly.

Certificates of excellence are issued to facilities that report 90% of their cases within 12 months. At first, only nine facilities received a certificate, but now almost 20 receive certificates each quarter.

Quarterly newsletters to registrars focus on one hot topic happening in the central registry, introduce a hospital registrar, list all recipients of the certificates of excellence, and offer questions and answers and training opportunities for registrars.

Webinar training via the Internet has been used several times for both new and experienced registrars.

The MCTR Advisory Group consists of new and experienced registrars who act as a sounding board for MCTR issues or processes. The Advisory Group was consulted when the MCTR was planning to revise the Administrative Rules and implement 2010 changes.

All hospitals using software for tumor registry management submit their data via the Montana FTP (82%). The FTP allows facilities to report cases timely and securely.

MCTR data are used consistently in the Comprehensive Cancer Control Program. Accurate and complete data are essential for Montana's cancer planning. Timely and complete reporting can impact plans for cancer prevention and control.