Tumor registry aids in ongoing QI efforts
Data used to benchmark, meet practice guidelines
At the Cleveland Clinic Cancer Center at Fairview Hospital, "quality" is more than a word, says Susan Dunson, MSN, RN, OCN, administrator of oncology services. "Our mission statement includes the word 'quality,' and we're always looking for ways to measure it," she says.
That measurement, she continues, starts with benchmarks and national standards. "We use the National Comprehensive Cancer Network's [NCCN] practice guidelines," she says. "We have a multidisciplinary committee chaired by a physician that looks at these guidelines for each specific tumor site bi-monthly."
In addition to comparing its clinical practices to those guidelines outlined as best practices, other quality indicators are used, particularly from the National Quality Forum and the American College of Surgeons' Commission on Cancer, which have chosen six indicators to monitor.
This naturally requires a lot of data, the collection of which, says Dunson, is enabled by the Cancer Tumor Registry maintained at the hospital. "The data we need can generally be accessed through the general data collection fields of the registry," she explains.
One requirement, different models
Every state, Dunson explains, has mandatory cancer incidence reporting. "The state of Ohio reports through a branch of the Ohio Department of Health called OCISS — the Ohio Cancer Incidence and Surveillance System," she says.
The tumor registry at her facility has many data fields, including demographics, pathology, cystology, grade, size, and lymph node involvement. "It also records the treatment provided, which may include surgery, chemotherapy, radiation, or hormonal therapies," she adds.
A tumor registry, she continues, is a group of individuals "who are hopefully CTRs [certified tumor registrars], who abstract data from patient charts. It is their job to report these data to the state," she notes. While all facilities in the state are required to have a registry, "some hire their own CTRs, while others use a staffing service," Dunson says.
Her registrars sit on the performance improvement committee. "They have a place at the table," she notes. "They also sit on the cancer committee itself, which is the governing body."
The registry data also played a key role in the facility recently receiving a Commission on Cancer accreditation. "We earned accreditation with commendation, and the registrars were a big part of that team," says Dunson. "That [accreditation] speaks to the quality of a program, as it is recognized nationally and is good for three years."
Outcomes are tracked
The registry is particularly helpful in tracking outcomes, notes Dunson. "Patients are followed for years to provide long-term data — which is wonderful when you want to find survival rates over five years," she notes. It's critical to report these data accurately, Dunson emphasizes. "So if the registry can't find some particular information, we use an RN, who is experienced with cancer treatments to retrieve the data. If the patient did not receive all the elements of care we would expect, we ask an RN to review the chart to find the reason an element was missing. Was the element missing due to patient choice or a system or process issue? Any patient management outliers are discussed at the cancer performance improvement committee, where physicians evaluate the quality of care rendered," she says.
For example, one of the NQF measures is radiation therapy administration within one year of diagnosis for women under 70 years old receiving breast-conserving surgery for breast cancer. "If the field in the tumor registry is not complete, we send a nurse into that chart to find out why it was not given; perhaps the patient moved out of state and we lost the ability to track them; perhaps they refused the treatment for some reason, or they just failed to come in for the treatment." The reason this extra level of research is employed, she explains, is because "our goal is always 100% compliance."
As science and technology develop, Dunson continues, the registrars track new and different elements. "For example, sentinel node breast biopsy was added as a new metric in the standard of care, so we monitor it monthly," she says. "We also monitor breast-conserving surgery monthly — did they have a lumpectomy or a mastectomy? Where we find a system failure, we change policy and educate everyone involved in the care of that patient to prevent it from happening again."
Each unit tracks different metrics, Dunson adds. "For example, nursing tracks pain, radiation tracks treatment accuracy, social workers monitor each support group session with a questionnaire, and breast nurse navigators track the time it takes to get from an abnormal mammogram to biopsy."
[For additional information, contact:
Susan Dunson, MSN, RN, OCN, Administrator of Oncology Services, Cleveland Clinic Cancer Center at Fairview Hospital. Phone: (216) 476-7000.]
At the Cleveland Clinic Cancer Center at Fairview Hospital, "quality" is more than a word, says Susan Dunson, MSN, RN, OCN, administrator of oncology services. "Our mission statement includes the word 'quality,' and we're always looking for ways to measure it," she says.You have reached your article limit for the month. Subscribe now to access this article plus other member-only content.
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