Step 5: Decide if retrospective data clean-up is right for your practice

steps This section covers the following steps:

Step 5.1 Assess the pros and cons of retrospective versus prospective data clean-up
Step 5.2 Request a list of women in your practice who have attended BreastScreen NSW
Step 5.3 Ensure screening results are accurately recorded
Step 5.4 Check your practice refers women to BreastScreen NSW and private radiology appropriately

The steps outlined in this module so far will help you to clean up your data and establish more accurate cancer screening participation baseline data.

However, there may be other errors in how cancer screening data has been managed in your practice that requires a more labour-intensive response to correct them.

The most common issue is when paper-based BreastScreen NSW results have been managed in a way that cannot be ‘read’ by practice software or data audit tools, meaning that participation statistics and lists of under-screened patients are incorrect.

  • CAT4 will not recognise paper-based BreastScreen NSW results recorded via a practice software’s conditions, past history, investigations, correspondence in, reason for visit or past history functions.
  • CAT4 will only pick up test results that are as per those listed. (Step 2 of this module will correct this problem).
What does this mean?

If your practice has been managing BreastScreen NSW results in a way that your data audit tool or practice software can’t recognise, then you need to decide the following:

  • Will you use the instructions in Module 2 to ensure that, from this point forward, your practice correctly handles cancer screening results, so that, over time, your data will become complete (i.e. you will prospectively clean up your patient data)?
  • In addition to the step above, will you review patient files to ensure results are recorded in a way that data audit tools and practice software can read (i.e. you will retrospectively clean up your patient data)?

Step 5.1 Assess the pros and cons of retrospective versus prospective data clean-up

Retrospective
Pro Con
Accurate participation figures established faster Very time-consuming
Accurate reminder list established faster Time required to clean up data can limit engagement in other areas of cancer screening quality improvement
Higher level of certainty that you are reminding all eligible patients to attend BreastScreen NSW Time required may limit practice decision- makers’ support for cancer screening quality improvement
Prospective
Pro Con
Avoids the team getting ‘bogged down’ by data cleaning It may take up to two years to be able to generate an accurate list of patients overdue to attend BreastScreen NSW
Allows more time to focus on other cancer screening quality improvement activities If you want to send BreastScreen NSW reminders from your practice, manual review (see Module 3) of reminder lists will be required until the data is clean.
Real-life experience

Real-life experience

“Until recently, BreastScreen NSW results were sent in paper form to GPs. This was really time consuming for practices and sometimes limited their engagement in the full range of cancer screening quality improvement activities. However, we did see that creating an accurate reminder list was really important. Many patients who were not responding to BreastScreen NSW reminders, did respond to reminders from their practice. What’s important is for practices to assess their cancer screening goals and decide what level of retrospective clean-up is right for them.”

- Kath Duggan, Integrated Health Care, Cancer screening, Hunter New England and Central Coast PHN

Step 5.2 Request a list of women in your practice who have attended BreastScreen NSW

Use the ‘BreastScreen NSW GP Form’ to request a list of women who have attended BreastScreen NSW and listed a doctor from your practice as their GP.

Step 5.3 Ensure screening results are accurately recorded

Step 5.3.1 Check that results for patients on the list provided by BreastScreen NSW have been recorded as a test result using a recognised test result

(see Step 2.1 for recognised test results).

Step 5.3.2 For patients whose BreastScreen NSW result has not been recorded as a test result, you will need to manually enter their test result

PENCS provides instructions on how to enter test results for Best Practice and Medical Director, scroll down to Mammogram for the instruction.

Step 5.4 Check your practice refers women to BreastScreen NSW and private radiology appropriately

Sometimes practices refer women to private providers for mammograms who should be directed to BreastScreen NSW.

There are no MBS item numbers that cover mammography for screening of asymptomatic patients. A woman sent to a private provider for a screening mammogram may incur the full cost of the service.

Diagnostic radiology is appropriate for:

Diagnostic radiology is optimised to solve diagnostic problems. It has increased sensitivity and may have reduced specificity, this is appropriate for symptomatic women but may create a risk of ‘over-biopsy’ in asymptomatic women.

Step 5.4.1 Print 'Knowledge check': The difference between BreastScreen and private provider mammography’ and provide a copy to your clinical team
Step 5.4.2 Assess if members of your practice team are/have referred women to private provider mammography who should be screened at BreastScreen NSW
Step 5.4.3 As a team, decide on your practice policy for breast cancer screening referrals of asymptomatic women
Step 5.4.4 Consider undertaking a clinical review of patients who have had a bilateral mammogram through a private imaging provider to identify which of these women should be redirected to BreastScreen NSW for their next mammogram.
  • Options for generating lists of patients who had a bilateral mammogram through a private imaging provider are as follows:
    • Extract a list of patients aged 50–74 who have had a bilateral mammography result from a diagnostic imaging provider (see the table below). OR
    • Request a list from your preferred diagnostic imaging provider/s of your patients aged 50–74 who have had a bilateral mammogram under item numbers 59300/59301.
  • It is important that a clinician identifies the next appropriate screening interval for these patients.

Note: You will need to select your preferred search timeframe for results. Two years is recommended because patients outside of this timeframe are overdue for screening and should be picked up via the recall and reminder processes that will be established in Module 3.

Electronic transmission of BreastScreen NSW results

If your practice meets the pre-requisites for receiving BreastScreen NSW results electronically, then you should have been receiving electronic results since late 2018. The pre-requisites are as follows:

  • Your practice must have an active account with Medical Objects or HealthLink.
  • Your practice must use either Medical Director or Best Practice software.
  • Your practice must be based in NSW or border-sharing locations.

Once secure messaging from BreastScreen NSW is enabled at your practice, the following results will be delivered electronically to your practice software, and will no longer be delivered via post:

  1. Normal Result: No evidence of breast cancer detected
  2. Normal Result: No evidence of breast cancer detected, but a breast change was reported; GPs to follow up
  3. Return to Assessment: Client to attend BreastScreen NSW Assessment Clinic
  4. Assessment Outcome Report of clients who have NOT undergone biopsy.

If your practice does not have the above-mentioned prerequisites, it will be unaffected by this change and continue to receive all BreastScreen NSW results via post/fax.

If your practice is not currently eligible for electronic results, it is very important to work with your practice team to introduce and maintain consistent management of paper-based results, as per the guidance outlined in Modules 2 and 3.

Ensuring paper-based BreastScreen NSW results are coded in the results section of your practice software (using test result names) will enable the use of CAT4 to identify women overdue for screening and to monitor BreastScreen NSW participation rates in your practice.