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Quality Control

Quality control procedures must be implemented to ensure complete reporting of all reportable cases. This quality control function should be performed semiannually, at a minimum, to allow for immediate correction of identified underreported areas. If the number of reportable cases in the database has dropped by midyear, the registrar should verify that all sources of casefinding have been reviewed. A monitoring log can help in this process but is not required. Below is an example of a monitoring log.

Sample Casefinding Completeness Log

Casefinding Completeness Log - 1999
  Jan Feb Mar Apr May Jun Jul Aug Sep Oct Nov Dec
Adm & Dis                        
Dis Index                        
Surg Schedule                        
Path                        
Cyto                        
Nucl Med                        
Rad Onc                        
Med Onc                        
Autopsy                        
Other                        

Other examples of quality control procedures for casefinding include comparing monthly cases in previous years with the current period. Again, this type of log can be useful, but is not required. A sample casefinding completeness log by month and year of diagnosis is provided below.

Sample Casefinding Completeness Log by Month and Year of Diagnosis

Casefinding Completeness Log by Month and Year of Diagnosis
Month Number of Cases, 2000 Number of Cases, 2001
January 60 85
February 50 60
March 65 72
April 58 50
May 52 61
June 61 64
July 45 57
August 32 62
September 65 72
October 62 78
November 70 80
December 40 62

In the example above, the decrease in cases in July and August 2000 might correlate with a primary physician taking an extended vacation. The decrease in cases for December 2000 and the increase in January 2001 may be due to a specialty group of physicians leaving the institution in December and the arrival of a new oncology group in January. Fluctuations like those shown in this example should be reviewed and justified when differences are identified to ensure that casefinding is complete. The easiest way to accomplish this task is to request the disease indices again for the month in question so that patterns that deviate from previous months can be reviewed.

On a hospital and regional level, comparison of sites by the year of the diagnosis can be helpful. A sample casefinding completeness log by site and year of diagnosis is also provided below. This type of evaluation can show a decrease in outpatient visits, possible lack of coding or change in coding mechanism, use of a different laboratory for outpatient visits, physician change in facility preference, or patient movement to an outpatient physician office setting.

Sample Casefinding Completeness Log by Site and Year of Diagnosis

Casefinding Completeness Log by Site and Year of Diagnosis
Site 2000 2001
Breast 91 104
Prostate 85 61
Melanoma 26 11
Lymphoma 25 24
Cervix 18 2

On a regional and state level, comparison of facilities by year could identify increases or decreases in cases. Increases may be due to the opening of a new cancer center or a different marketing approach. Decreases can be attributed to a facility closing, loss of an industry, or physicians leaving the area. Although these increases or decreases may be explainable, the reasons should be evaluated. Regularly monitoring casefinding enables the registrar to identify potential problems and suggest corrections.