Using Audit Results as a Training Opportunity

Nevada Central Cancer Registry

CDC's National Program of Cancer Registries (NPCR) performed a data completeness and quality audit (DCQA) on Nevada Central Cancer Registry (NCCR) data in 2009 for the 2006 diagnosis year. Although the NCCR passed the audit at 99.76% for overall case completeness for cancer sites audited and 93.96% for overall data accuracy, this exercise revealed a higher than expected percentage of discrepancies in all records reviewed, presenting many opportunities for improvement for both hospital reporters and internal NCCR staff.

The NCCR was in the early stages of planning its biannual Statewide Cancer Registration Workshop when the audit results were revealed. It was quickly decided to use the audit results to drive the agenda. NCCR staff and the NPCR audit team analyzed the data and developed presentations. The registry's NPCR project officer helped present audit findings and their implications, and helped develop training relevant to those findings. It was decided to focus on breast cancer as a theme, since this site represented the highest percentage (30.4%) of the total number of overall discrepancies.

The 2½-day training workshop entitled "Change Is A-Comin': Topics in Cancer Registration 2009" began with sharing the audit results with an explanation of what that meant at the hospital registry level, showing participants the value of Nevada cancer data, how their data are used, and their role in the end product. The rest of the time was focused on the breast site, addressing common coding errors, CSv2, coding treatment information, importance of text, using the Multiple Primary and Histology Rules, and coding known versus unknown. To bring the importance of correct coding home, one half day was spent with the Chief of Clinical Oncology and Hematology Services at the Nevada Cancer Institute, who shared dynamic information about understanding the staging and treatment of breast cancer.

The workshop was quite successful—

• The hospital reporters who attended participated very actively.
• The presentations were very well received by the participants.
• There have been fewer questions about coding the breast site since the workshop.
• 18.5 continuing education units (CEUs) were awarded to the NCCR for the 2½-day workshop, a testament to the quality of the program.

As a result of the workshop—

• Hospital reporters are better equipped to abstract cases accurately based on feedback from real cases.
• Reporters with a better understanding of coding processes can provide better and more complete data, ultimately improving data accuracy.
• Certified tumor registrars helped maintain their credentials by acquiring up to 18.5 free CEUs.
• Critical information has been provided to help abstractors collect and report complete, high-quality data to the NCCR, decreasing edits done by NCCR staff on future hospital submissions.
• NCCR data are more complete and have the quality needed for research and cancer education and prevention efforts.
• Audit feedback was provided and higher quality data can be sent back to the reporting hospital, where physicians and administrators may use the data for training, education, prevention efforts, treatment evaluations, and trend analysis.