Discrete Data Field (DDF) Synoptic Cancer Pathology Reporting Enables Timely Prognostic Factor Analysis and Quality Indicator Reporting: A Population-Based Study of 4296 Resection Reports
JR Srigley, D Divaris, T McGowan, M Yurcan, J Ross, K Milnes, J Mazuryk, R McCleod, J Irish, C Sawka. Cancer Care Ontario, Toronto, ON, Canada; McMaster University, Hamilton, ON, Canada; University of Toronto, Toronto, ON, Canada
Background: Standardized cancer pathology reports (CPRs) facilitate clinical management and data collection by cancer registries, accrediting bodies and planning agencies. In Ontario (population 13 million) we have previously shown that single text field synoptic reporting improves completeness of CPRs based on College of American Pathologists (CAP) checklist standards (J Surg Oncol 99:517-24, 2009). Previous studies used resource-intensive manual auditing. Since 2008, Cancer Care Ontario (CCO) has implemented electronic tools (e-tools) for DDF synoptic CPRs thus enabling automated quality indicator reporting.
Design: CCO receives about 90% of all CPRs (about 137,000 per year) from Ontario hospitals through an electronic pathology system (e-Path). CPR content standards based on CAP checklists (2005) and common formatting and messaging standards were developed for breast, colorectal, lung, prostate, endometrium CPRs. CCO assisted hospitals to implement e-tools for DDF synoptic reporting through e-Path. Quality indicators were developed including % CPRs submitted in DDF format, % DDF CPRs complete against CAP standards, % DDF colorectal CPRs with 12 or more lymph nodes examined and % DDF radical prostatectomy CPRs with positive margins in setting of pT2 disease.
Results: Between May 2008 to August 2009, 15/46 primary e-Path reporting hospitals and 16 associated secondary hospitals implemented e-tools and reported against CCO standards. The % CPRs submitted in DDF synoptic format was 3965/4296 = 92%. 3723/3965 (94%) DDF reports were complete against CAP standards for applicable disease sites. In August 2009, 22% of CPRs (450/2033) for all resections were received in DDF format. CCO has operationalized the completeness indicator process with monthly reporting to hospitals. With respect to surgical pathology quality indicators, 583/643 (91%) colon and 239/269 (89%) rectal and rectosigmoid resections had 12 or more lymph nodes examined. The overall rates of margin positivity for pT2 prostate cancer based on radical prostatectomy reports was 117/450 (26%).
Conclusions: Standardization of CPRs in DDF format automates and facilitates data usage for multiple purposes including cancer registration, stage capture, population-based cancer research and reporting performance metrics related to quality indicators.
Category: Quality Assurance
Monday, March 22, 2010 1:00 PM
Poster Session II # 211, Monday Afternoon