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Edwards P, Bernacet A, Tangka FKL, Pordell P, Beizer J, Wilson R, Blumenthal W, Jones SF, Cole-Beebe M, Subramanian S. Operational Characteristics of Central Cancer Registries that Support the Generation of High-Quality Surveillance Data. J Registry Manag 2022; 49:10-16. [PMID: 36968178 PMCID: PMC10036081] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 03/29/2023]
Abstract
Objectives We aim to assess external and internal attributes and operations of the Centers for Disease Control and Prevention (CDC)'s National Program of Cancer Registries (NPCR) central cancer registries by their consistency in meeting national data quality standards. Methods The NPCR 2017 Program Evaluation Instrument (PEI) data were used to assess registry operational attributes, including adoption of electronic reporting, compliance with reporting, staffing, and software used among 46 NPCR registries. These factors were stratified by (1) registries that met the NPCR 12-month standards for all years 2014-2017; (2) registries that met the NPCR 12-month standards at least once in 2014-2017 and met the NPCR 24-month standards for all years 2014-2017; and (3) registries that did not meet the NPCR 24-month standards for all years 2014-2017. Statistical tests helped identify significant differences among registries that consistently, sometimes, or seldom/never achieved data standards. Results Registries that always met the standards had a higher level of electronic reporting and a higher compliance with reporting among hospitals than registries that sometimes or seldom/never met the standards. Although not a statistically significant finding, the same registries also had a higher proportion of staffing positions filled, a higher proportion of certified tumor registrars, and more quality assurance and information technology staff. Conclusions This information may be used to understand the importance of various factors and characteristics, including the adoption of electronic reporting, that may be associated with a registry's ability to consistently meet NPCR standards. The findings may be helpful in identifying best practices for processing high-quality cancer data.
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Affiliation(s)
| | | | | | - Paran Pordell
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Jenny Beizer
- RTI International, Research Triangle Park, North Carolina
| | - Reda Wilson
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Sandra F. Jones
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Tangka FKL, Edwards P, Pordell P, Wilson R, Blumenthal W, Jones SF, Jones M, Beizer J, Bernacet A, Cole-Beebe M, Subramanian S. Factors Affecting the Adoption of Electronic Data Reporting and Outcomes Among Selected Central Cancer Registries of the National Program of Cancer Registries. JCO Clin Cancer Inform 2021; 5:921-932. [PMID: 34464161 DOI: 10.1200/cci.21.00083] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
PURPOSE The CDC's National Program of Cancer Registries has expanded the use of electronic reporting to collect more timely information on newly diagnosed cancers. The adoption, implementation, and use of electronic reporting vary significantly among central cancer registries. We identify factors affecting the adoption of electronic reporting among these registries. METHODS Directors and data managers of nine National Program of Cancer Registries took part in separate 1-hour telephone interviews in early 2019. Directors were asked about their registry's key data quality goals; staffing, resources, and tools used to aid processes; their definition and self-perception of electronic reporting adoption; key helpers and challenges; and cost and sustainability implications for adoption of electronic reporting. Data managers were asked about specific data collection processes, software applications, electronic reporting adoption and self-perception, information technology infrastructure, and helpers and challenges to data collection and processing, data quality, and sustainability of approach. RESULTS Larger registries identified organizational capacity and technical expertise as key aides. Other help for implementing electronic reporting processes came from partnerships, funding availability, management support, legislation, and access to an interstate data exchange. Common challenges among lower adopters included lack of capacity at both registry and data source levels, insufficient staffing, and a lack of information technology or technical support. Other challenges consisted of automation and interoperability of software, volume of cases received, state political environment, and quality of data received. CONCLUSION Feedback from the formative evaluation yielded several useful solutions that can guide implementation of electronic reporting and help refine the technical assistance provided to registries. Our findings may help guide future process and economic evaluations of electronic reporting and identify best practices to strengthen registry operations.
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Affiliation(s)
| | | | - Paran Pordell
- Centers for Disease Control and Prevention, Atlanta, GA
| | - Reda Wilson
- Centers for Disease Control and Prevention, Atlanta, GA
| | | | - Sandy F Jones
- Centers for Disease Control and Prevention, Atlanta, GA
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Tangka FKL, Subramanian S, Hoover S, Cole-Beebe M, DeGroff A, Joseph D, Chattopadhyay S. Expenditures on Screening Promotion Activities in CDC's Colorectal Cancer Control Program, 2009-2014. Prev Chronic Dis 2019; 16:E72. [PMID: 31172915 PMCID: PMC6583814 DOI: 10.5888/pcd16.180337] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Introduction The Centers for Disease Control and Prevention (CDC) established the Colorectal Cancer Control Program (CRCCP) in 2009 to reduce disparities in colorectal cancer screening and increase screening and follow-up as recommended. We estimate the cost for evidence-based intervention and non–evidence-based intervention screening promotion activities and examine expenditures on screening promotion activities. We also identify factors associated with the costs of these activities. Methods By using cost and resource use data collected from 25 state grantees over multiple years (July 2009 to June 2014), we analyzed the total cost for each screening promotion activity. Multivariate analysis was used to assess the factors associated with screening promotion costs reported by grantees. Results The promotion activities with the largest allocation of funding across the years and grantees were mass media, patient navigation, outreach and education, and small media. Across all years of the program and across grantees, the amount spent on specific promotion activities varied widely. The factor significantly associated with promotion costs was region in which the grantee was located. Conclusion CDC’s CRCCP grantees spent the largest amount of the screening promotion funds on mass media, which is not recommended by the Community Preventive Services Task Force. Given the large variation across grantees in the use of and expenditures on screening promotion interventions, a systematic assessment of the yield from investment in specific promotion activities could better guide optimal resource allocation.
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Affiliation(s)
- Florence K L Tangka
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, 4770 Buford Hwy, NE, MS F-76, Atlanta, GA 30341-3717.
| | | | | | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba Joseph
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Subramanian S, Tangka FKL, Hoover S, Cole-Beebe M, Joseph D, DeGroff A. Comparison of Program Resources Required for Colonoscopy and Fecal Screening: Findings From 5 Years of the Colorectal Cancer Control Program. Prev Chronic Dis 2019; 16:E50. [PMID: 31022371 PMCID: PMC6513474 DOI: 10.5888/pcd16.180338] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Introduction Colonoscopy and guaiac fecal occult blood tests and fecal immunochemical tests (FOBT/FIT) are the most common colorectal cancer screening methods in the United States. However, information is limited on the program resources required over time to use these tests. Methods We collected cost data from 29 Centers for Disease Control and Prevention Colorectal Cancer Control Program (CRCCP) grantees by using a standardized data collection instrument for 5 program years (2009–2014). We created a panel data set with 124 records and assessed differences by screening test used. Results Forty-four percent of all programs (N = 124) offered colonoscopy (55 of 124), 32% (39 of 124) offered FOBT/FIT, and 24% (30 of 124) offered both. Overall, total cost per person was higher in program year 1 ($3,962), the beginning of CRCCP than in subsequent program years ($1,714). The cost per person was $3,153 for programs using colonoscopy and $1,291 for those using FOBT/FIT with diagnostic colonoscopy. The average clinical cost per person was $1,369 for colonoscopy and $280 for FOBT/FIT during the program (these do not reflect cost of repeated FOBT/FIT screens). Programs serving a large number of people had lower per-person costs than those serving a small volume, probably because of fixed costs related to nonclinical expenses. Conclusion Colorectal cancer screening programs incur costs in addition to the clinical cost of the screening procedures to support planning and management, contracting with providers, and tracking patients. Because programs can achieve potential economies of scale, partnerships among smaller programs for screening delivery could decrease overall costs.
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Affiliation(s)
- Sujha Subramanian
- RTI International, 307 Waverley Oaks Rd, Ste 101, Waltham, MA 02452.
| | | | | | | | - Djenaba Joseph
- Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Hoover S, Subramanian S, Tangka FKL, Cole-Beebe M, Sun A, Kramer CL, Pacillio G. Patients and caregivers costs for colonoscopy-based colorectal cancer screening: Experience of low-income individuals undergoing free colonoscopies. Eval Program Plann 2017; 62:81-86. [PMID: 28153341 PMCID: PMC5847315 DOI: 10.1016/j.evalprogplan.2017.01.002] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2016] [Accepted: 01/04/2017] [Indexed: 05/18/2023]
Abstract
Many studies have documented barriers to colorectal cancer screenings. However, there is lack of comprehensive information on the time and costs borne by low-income patients and the persons accompanying the patient (caregiver) for colonoscopies in the United States. We surveyed patients in three health clinics in Philadelphia retrospectively who had undergone free colonoscopies in the previous 18-month period. Participants were asked questions about time and out-of-pockets expenses for themselves and their caregivers. Even when colonoscopies were free to the patient through Colorectal Cancer Control Program funded by the Centers for Disease Control and Prevention, the patient and caregivers still incurred costs in relation to preparing for, undergoing, and recovering from a colonoscopy. These costs can be substantial and may account for some of the low colorectal cancer screening rates especially among the low-income populations. Patients' and caregivers' costs need to be considered when designing and implementing colorectal cancer control programs.
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Affiliation(s)
- Sonja Hoover
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Sujha Subramanian
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA.
| | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop K-76, Atlanta, GA 30341-3717, USA
| | - Maggie Cole-Beebe
- RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452, USA
| | - Amy Sun
- RTI International, 307 Waverley Oaks Road, Waltham, MA 02452, USA
| | - Cheryl L Kramer
- Philadelphia Department of Public Health, Health Center 4, 4400 Haverford Avenue, Philadelphia, PA 19104, USA
| | - Gina Pacillio
- Philadelphia Department of Public Health, Health Center 4, 4400 Haverford Avenue, Philadelphia, PA 19104, USA
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Tangka FKL, Subramanian S, Edwards P, Cole-Beebe M, Parkin DM, Bray F, Joseph R, Mery L, Saraiya M. Resource requirements for cancer registration in areas with limited resources: Analysis of cost data from four low- and middle-income countries. Cancer Epidemiol 2016; 45 Suppl 1:S50-S58. [PMID: 27793574 PMCID: PMC5842435 DOI: 10.1016/j.canep.2016.10.009] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Revised: 10/12/2016] [Accepted: 10/15/2016] [Indexed: 10/20/2022]
Abstract
BACKGROUND The key aims of this study were to identify sources of support for cancer registry activities, to quantify resource use and estimate costs to operate registries in low- and middle-income countries (LMIC) at different stages of development across three continents. METHODS Using the Centers for Disease Control and Prevention's (CDC's) International Registry Costing Tool (IntRegCosting Tool), cost and resource use data were collected from eight population-based cancer registries, including one in a low-income country (Uganda [Kampala)]), two in lower to middle-income countries (Kenya [Nairobi] and India [Mumbai]), and five in an upper to middle-income country (Colombia [Pasto, Barranquilla, Bucaramanga, Manizales and Cali cancer registries]). RESULTS Host institution contributions accounted for 30%-70% of total investment in cancer registry activities. Cancer registration involves substantial fixed cost and labor. Labor accounts for more than 50% of all expenditures across all registries. The cost per cancer case registered in low-income and lower-middle-income countries ranged from US $3.77 to US $15.62 (United States dollars). In Colombia, an upper to middle-income country, the cost per case registered ranged from US $41.28 to US $113.39. Registries serving large populations (over 15 million inhabitants) had a lower cost per inhabitant (less than US $0.01 in Mumbai, India) than registries serving small populations (under 500,000 inhabitants) [US $0.22] in Pasto, Colombia. CONCLUSION This study estimates the total cost and resources used for cancer registration across several countries in the limited-resource setting, and provides cancer registration stakeholders and registries with opportunities to identify cost savings and efficiency improvements. Our results suggest that cancer registration involve substantial fixed costs and labor, and that partnership with other institutions is critical for the operation and sustainability of cancer registries in limited resource settings. Although we included registries from a variety of limited-resource areas, information from eight registries in four countries may not be large enough to capture all the potential differences among the registries in limited-resource settings.
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Affiliation(s)
- Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA.
| | - Sujha Subramanian
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA
| | - Patrick Edwards
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA
| | - Maggie Cole-Beebe
- RTI International, 3040 E. Cornwallis Rd., Research Triangle Park, NC, USA
| | - D Maxwell Parkin
- Honorary Senior Research Fellow, Nuffield Department of Population Health, University of Oxford, Richard Doll Building, Old Road Campus, Roosevelt Drive, Oxford, OX3 7LF, United Kingdom
| | - Freddie Bray
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France
| | - Rachael Joseph
- United States Centers for Disease Control and Prevention, Nairobi, Kenya
| | - Les Mery
- Section of Cancer Surveillance, International Agency for Research on Cancer (IARC), Lyon, France
| | - Mona Saraiya
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, GA, USA
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