Transcript Using Collaborative Staging Data In Reports

Using Collaborative
Staging Data In Reports
Authored By Ted Williamson, MD, PhD, CTR
Teresa Mason, RHIT, CTR and Dianne
Cleveland, RHIA, CTR
Part One:
Collaborative Staging
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CS Task Force was organized in 1998
Develop a translation between TNM and SEER
Eliminate duplicate data collection by registrars
Address the concerns of clinicians for more clinically
relevant data
• Deal with data reproducibility over time
• Improve compatibility between SEER and NCDB and
expand data-sharing opportunities
CS Data Input Involves Just 13 Fields,
but, 9 Site-Specific Fields………
And 94 Different Sites, resulting in
1316 Coding Tables
The CS Innovation:
Standardized Calculation of Stage
• You enter data into the 13 fields.
• Your registry program passes this data plus histology,
behavior, grade, age to a program developed at CDC.
• The CDC program runs edits. If no errors are found,
computes derived AJCC TNM and SEER staging.
• The CDC program passes results back to your registry
software system.
CS Data Is Returned in Two Formats
T
• Storage codes –
sent in NAACCR &
NCDB records.
Software must store
them but may not
display them.
• Display strings physician and
registrar friendly.
S
CS - In Summary
• CS is surprisingly functional in spite of its complexity.
• Benefits are CS long-term, particularly in stage-based
comparative studies of treatment and outcomes.
• Automated translation of data to summary codes
along with edits that identify CS coding errors help
maintain error free data.
• CS is not saving abstracting time!
Part Two:
Exploring Ways To Use CS Data
How to extract the CS data
from your software system
in various forms such as
spreadsheets, using tools
such as MS Excel.
You got it in, now let’s see
how to get it out!
Proposed Project:
Staging Quality Assessment
• Question: How does physician TNM staging
compare to CS TNM derived staging?
• How do we present this?
• Suggested Data Fields:
– Basic diagnostic fields
– Physician TNM & CS TNM Derived Staging
– Any other pertinent standard or custom
user-defined data fields
Good Points to Remember
(before getting started)
• Make the spreadsheet format and content as general as
possible. You may want to use it over and over again.
• We suggest you export as a TAB delimited text file. This
will give you important flexibility when you bring the
data back into Excel. Include column headers.
• If you can, export staging data in the NAACCR reporting
format (1A, 3B, etc.) rather than the classic form (T1A,
SIIIB, …) or the CS storage code (29, 30, 31, 32, …).
Much easier to work with.
If Your Excel Toolbar Looks Like
This…
You’re not ready to go to work yet.
Essential Excel Tool Buttons for
Registry Data Operations
14 Excel Buttons Essential to
Registry Work
Using Excel Import Wizard
Remove Unneeded Columns
The Result May Need Some Clean Up
• Some cases have no data.
• Many cases have one or
both stages marked as 99
or unknown.
• For some cases staging is
not applicable (88).
• Derived stage is in the
“classic” AJCC format.
• “A” and “B” subgroups
would be difficult to deal
with quantitatively.
Fortunately – Excel Has Tools
• Right click on
the corner box.
• The entire
worksheet is
highlighted.
Autofilters
• Click on the
“Autofilter” icon.
• Click on the arrow
by the cS column
header. A list of all
encountered
values appears.
• Click on “88.”
This Is a Cool Tool!
• You have filtered out
all but the rows with
a clinical stage
group of “88”.
• Click on first cell,
second row and
drag down to the
last row with data.
• Click on the “delete
rows” icon.
What Happened to My Data?
• Click again on the
autofilter arrow in
column B.
• The 88’s are
missing from the
occurrence table.
• Click on (All).
Nothing Lost!
• The data re-appears, without
rows containing ’88’.
•
• Repeat the process for the
99’s, blanks and other data
you can’t use in your study.
• As the occurrence table
shows, this column is clean.
• Now do the same for CS
Derived Stage.
Two Problems Remain
• For the report we need simple
Arabic numbers for
comparison.
• Derived stage is in Roman
numerals.
• Both staging systems have
suffix A’s, B’s, etc.
Tidy up the Romans
First
• Click on the column label cell – the
column is highlighted.
• Click Edit on the menu bar.
• Click Replace on the menu.
• Enter “IV” in Find what and
“4” in Replace with:
• Click Replace All.
Repeat the process for
III, II, and I
Get Rid of The
Suffixes
• Click in D2 and enter the
formula “=LEFT(B2,1)”.
• This captures the first
character in cell B2 and
places it in D2.
• Now, click on D2, put your
cursor on the little square
in the lower right corner
and drag down to fill all
the rows.
Repeat in Column E
• Copy D2 to E2 (the
formula is copied and
updated for cell
position).
• Copy the contents of
E2 down the column.
• Mission accomplished!
Doing the Math
• Click in F2 and enter the
formula “=D2-E2”
• Click again in F2 and
drag on the corner, down
the column.
• The result is a table of
differences between
physician TNM stage and
CS derived stage.
Label and Mark
• Put a label in F1
• Click in the middle of
F1 and drag down to
the bottom row with
data.
Launch Pivot
Table
• Click on the Pivot
Table button.
• Click Next on
Wizard Step 1.
• Click Next on Wizard
Step 2.
• Click Finish on
Wizard Step 3.
• Excel is really smart.
Drag
• Drag column title to
“Drop Row Fields
Here”.
• Drag column title to
“Drop Data Items
Here.
Almost There!
• Excel calculated a
numeric sum for each
score.
• Click on the Pivot
Table Field button.
• Change Summarize
by to “Count” and
click OK.
That’s Better
• Now the “Total”
represents the
number of cases with
each score.
• To present the data in
a graph format, click
on the graph button.
The First Cut – You Will Need To
Tune It Up
•Right Click in the
“Count” Box
•Select Hide…
After Using Some Standard Excel
Chart Formatting Tools…
With These Basic Principles, Many
Questions Can Be Answered With CS Data
• How does ER status correlate to hormone use in
breast cancer patients.
• What is the average number of lymph nodes resected
in Stage III colorectal cancer?
• How often are colorectal cases upstaged by surgery?
• Which doctor does the best staging?
• Which sites are most successfully staged?
More QA Opportunities
Some Ideas:
Use custom fields
to code deviations
such as physician
TNM vs Derived.
Quality Assurance Opportunities
• Identify data discrepancies
• Determine why there are
discrepancies (physician education,
registry staff training, etc)
• Develop a plan to resolve the issue
• Implement the plan
• Measure the results
Comparing SEER Summary 2000 to
Derived SEER
Consider looking
at differences in
SEER Summary
Staging and
Derived SEER.
Using Collaborative Staging Data In
Reports
Start using your
CS data.
You got it in, now
you know how to
get it out.