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U.S. National Institutes of Health National Cancer Institute

Quality Improvement Tools

Quality improvement studies of various types, including casefinding, and reliability, are conducted in even number calendar years. Casefinding audits are carried out by the QI central registry representatives under the direction of NCI SEER personnel. The auditors travel to registries other than their own when performing audits for NCI SEER.

In odd numbered calendar years, education and training programs are conducted at selected SEER registries and in conjunction with the annual meeting of the National Cancer Registrars Association. These training programs focus on problem areas identified through the quality control studies and cover changes introduced in data collection procedures.

Reliability Studies

NCI SEER conducts a number of web-based reliability studies as a vital part of the quality improvement process. The reliability study is a quality improvement process designed to test the skills of central and hospital registry personnel and to measure consistency in the application of codes and coding rules across a program. In a reliability study, all participants code information from the same medical records using the same references under similar conditions.

The quality improvement process of SEER reliability studies features a reconciliation component which focuses on uncovering the reasons for discrepant answers. Results of reliability studies are used to develop educational materials and to improve data collection manuals.
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Casefinding Studies

Casefinding or case ascertainment is the identification of all eligible cases to be included in the cancer registry database. Complete casefinding is necessary to ensure that cancer incidence rates are accurate. Both completeness and timeliness are evaluated based on contractual requirements
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NCI SEER no longer conducts reabstraction studies at the national level. Over the years, comparing hospital records to consolidated central registry records has become less effective due to inconsistencies. A great number of the discrepancies are due to the fact that the patient is treated in multiple locations and the consolidated record at the central registry level receives this additional information. Reabstracting studies are no longer a cost-effective way for NCI SEER to evaluate and improve the quality of the data. Central cancer registries and hospital cancer registries should continue to perform reabstraction studies. At the central and hospital levels, reabstraction is an effective and meaningful data evaluation tool.

New Methodology

The SEER Quality Improvement team is currently developing a new methodology to assess record consolidation at the central cancer registry level. The goals are to obtain an accurate measure of the data quality in the consolidated record and to identify opportunities for quality improvement while using NCI SEER resources in as efficiently as possible.

Data Quality Profile (DQP)

Another quality control tool is the Data Quality Profile which is generated annually for each SEER registry. This profile assesses the extent to which each registry provides data meeting certain contractual and other standards. For example, the DQP includes the percent of cases for which a specific data item is coded unknown and compares that result to the desired goal. Annual data are also subjected to trend analyses to identify areas needing improvement and to monitor outcomes from quality-oriented interventions. Registries with exceptional DQP results are recognized.