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 MCRHistorical: 1972 - voluntary agreementState mandate – 1984, implemented ‘85Received NPCR funding - 1995– Reference year - 1996Expanded reporting – 1999– 192.650 – 192.657 RSMoNAACCR certification – 1998 dx. yearNPCR quality indicators – ongoing ↑

MCR Database36,000 – 40,000 records per year28,000 unduplicated MO cases per year>300,000 unduplicated Missouri cases– 1996 and laterHistorical database - > 300,000 records– 1995 and earlier

Challenges We All FaceTimeliness: 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Early 1996:– Outdated hardware & software– Non-standard data elements & layout– Non-competitive salaries

• Outdated job specifications (pre-electronic)– Too few staff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 InformationJeannette Jackson-Thompson, MSPH, PhD

Operations Director, Missouri Cancer Registry andResearch Assistant Professor, Health Management

& Informatics, University of Missouri-ColumbiaPhone – 573 882-7775

Toll-free for reporting facilities – 1 800 292-2829E-mail – jacksonthompsonj@health.missouri.edu

MCR website: http://mcr.umh.edu

MCR Gold Celebration 2005