Recruitment and Retention of Tumor Registrars: the Missouri experienceJ. Jackson-Thompson, MSPH, PhD
Sue Vest, BA, CTRMissouri Cancer Registry,
University of Missouri, Columbia
Missouri Cancer Registry
• A collaborative partnership between the Missouri Department of Health & Senior Services (DHSS) and the University of Missouri - Columbia (MU); • Supported by CDC/NPCR Cooperative Agreement #U55/CCU721904-04 and a contract between the University of Missouri and the Missouri Department of Health and Senior Services
Acknowledgments
Sue Vest, CTR, MCR Project ManagerOthr MCR operations staff– Nancy Cole, CTR & Audra Herkelman (MCR)
Reporting facility staffCenters for Disease Prevention & Control National Program of Cancer Registries (CDC/NPCR)
Objectives
Brief history of Missouri Cancer Registry (MCR);Introduce MCR operations staff;Identify some ways MCR has successfully dealt with recruitment & retention; andOutline some challenges still to be faced.
MCR Gold Celebration 2005
History of MCR
Historical: 1972 - voluntary agreementState mandate – 1984, implemented ‘85Received NPCR funding - 1995– Reference year - 1996
Expanded reporting – 1999– 192.650 – 192.657 RSMo
NAACCR certification – 1998 dx. yearNPCR quality indicators – ongoing ↑
MCR Database
36,000 – 40,000 records per year28,000 unduplicated MO cases per year>300,000 unduplicated Missouri cases– 1996 and later
Historical database - > 300,000 records– 1995 and earlier
Challenges We All Face
Timeliness: 90% at 12 months; 95% at 24 monthsCompleteness: – ≥ 95% of expected cases– Treatment
Accuracy:– Pass edits: 100%– Missing/unknown data elements: ranges
from 2% - 3%• Race, sex, age, county of residence
– Death certificate only (DCE) cases ≤ 3%
Additional challenges many registries had (or still have)
Early 1996:– Outdated hardware & software– Non-standard data elements & layout– Non-competitive salaries
• Outdated job specifications (pre-electronic)– Too few staff
• Limited education & training opportunities• Difficulty retaining staff
1996
Assess the Situation
Need: Meet NPCR requirements
Timeliness, completeness and qualityExpanded cancer reporting statuteCase-sharing agreementsAdvisory BoardData in standard NAACCR layoutCollect required & recommended data elements
First Steps (Right off the Bat)
Increase NPCR fundingUpgrade hardware & buy commercial softwareHire more CTRs– Rewrite job specs to reflect responsibilities– Obtain permission to hire at top of pay scale– Make working for MCR desirable
Appoint Advisory BoardObtain case-sharing agreements
More Early Steps (Line Drives)
Improve relationships with reporting facilities– From “There’s a law - our way or the highway” to
“Partners for better patient outcomes”
Provide service to reporting facilities– Offer training for hospital registry staff– Go to bat for hospital CTRs – talk to administrators
Develop a constituency
Meet the Challenges …
And what do you get?
More Challenges!
1999 (Extra base hit)
Additional CTR positions funded by NPCR– No FTEs available
Revise plan– Strengthen existing external relationship– Decrease state government – eliminate FTEs
Outsource Operations!– Overnight, MCR operations staff became University
staff
Next Steps (Home run)
Impact of outsourcing– Greater flexibility in creating and filling positions– More understanding of need to maintain competitive
salaries, retain staff– Obtained NAACCR certification– Met most NPCR requirements
How? (Home run #2)
Flexible schedules for staff– Adjust hours to meet MCR staff needs– Added benefit – improved service to reporting facilities
Allow telecommuting, working off-site– Find a good CTR, don’t let distance/circumstances be an issue
Set standards– Must be CTR or CTR-eligible to be cancer data coordinator– If can’t find one, be creative – Health Program Assistant
Other Avenues (to the playoffs)
Increase training opportunities– Send all MCR staff to training of their choice– Develop/improve training for hospital registrars
Encourage staff to take advantage of tuition reimbursementRestructure operations to meet registry & staff needs
Further avenues (world series)
Promote from withinAnnual salary increasesEncourage staff to – Reach for the stars/achieve their dreams– Submit abstracts to NAACCR/make presentations– Get involved in research proposals
Build a winning team
In Their Own Words
Database Management Unit
Saba Yemane, BS
Database Administrator
Iris Zachary, BS, CTR
Assistant Database Administrator
Quality Assurance Unit - Electronic
Deb Smith, CTR
Senior Cancer Registrar
Cate Ellis, CTR, BSN
Cancer Data Coordinator
Quality Assurance Unit – Manual and Circuit-riding
Brenda Lee, CTR
Senior Cancer Registrar
Keri Grier
Health Program Assistant
Audit Unit
Debbie Douglas, CTR
Senior Cancer Registrar
Non-hospital Unit
Nancy Cole, CTR
Senior Cancer Registrar
Debra Eccleston
Health Program Assistant
Administration
Jeannette Jackson-Thompson, MSPH, PhD,
Operations Director
Sue Vest, CTR
Project Manager
Surveillance, Research and Special Projects Unit
Gonza Namulanda, MS
Research Assistant
Gentry White, BA, BS, MA, PhD Candidate
Research Assistant
Audra Our Office Support Staff
Challenges Still to be Faced
Hospital pay scales outstripping MCR pay scales– Department & University HR supportive
Change from exempt to hourly for CTRsNeed for additional positionsRestrictions placed on contract
Staff Frustrations & Wishes
More staff in QA, Non-hospital and Audit unitsSalary commensurate with responsibilities, training & expertiseSpaceTwo bureaucracies – MU & DHSS– Lack of knowledge about registry operations– Lack of support
Not enough time
Where are we now?
NPCR Quality Indicators
Dx Year200320022001200019991998
Age Sex Race Co.0.00 0.00 0.47 0.010.01 0.00 0.40 0.010.00 0.00 0.16 0.000.00 0.00 0.28 0.020.00 0.00 0.32 0.010.00 0.00 0.22 0.02
Can we stop here?
Overall completeness exceeds 95% at 24 monthsCompleteness estimates vary – By race and sex– By site
The Future
Electronic reporting capabilitiesIncreased information on web siteMore non-hospital reportingMore use of database for research
Research
Trends– Incidence– Stage at Dx– Treatment– Age, sex, race/ethnicity
Public health practiceOutcomes
Contact Information
Jeannette Jackson-Thompson, MSPH, PhDOperations Director, Missouri Cancer Registry
andResearch Assistant Professor, Health
Management & Informatics, University of Missouri-Columbia
Phone – 573 882-7775Toll-free for reporting facilities – 1 800 292-2829E-mail – [email protected]
MCR website: http://mcr.umh.edu
MCR Gold Celebration 2005