ecqm.measure

CMS129v8 - Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients

Rationale:

Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients. Multiple studies have indicated that a bone scan is not clinically necessary for staging prostate cancer in men with a low (or very low) risk of recurrence and receiving primary therapy. For patients who are categorized as low-risk, bone scans are unlikely to identify their disease. Furthermore, bone scans are not necessary for low-risk patients who have no history or if the clinical examination suggests no bony involvement. Less than 1% of low-risk patients are at risk of metastatic disease. While clinical practice guidelines do not recommend bone scans in low-risk prostate cancer patients, overuse is still common. An analysis of prostate cancer patients in the SEER-Medicare database diagnosed from 2004-2007 found that 43% of patients for whom a bone scan was not recommended received it (Falchook, Hendrix, & Chen, 2015). The analysis also found that the use of bone scans in low-risk patients leads to an annual cost of $4 million dollars to Medicare. The overuse of bone scan imaging for low-risk prostate cancer patients is a concept included on the American Urological Association's (AUA) list in the Choosing Wisely Initiative as a means to promote adherence to evidence-based imaging practices and to reduce health care dollars wasted (AUA, 2013). This measure is intended to promote adherence to evidence-based imaging practices, lessen the financial burden of unnecessary imaging, and ultimately to improve the quality of care for prostate cancer patients in the United States.

Data Elements

ProstateCancerDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Prostate Cancer valueset (2.16.840.1.113883.3.526.3.319)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

ProstateCancerDiagnosis

0..*

PainRelatedToProstateCancerDiagnosis

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

ResultValue constrained to codes in the Pain Related to Prostate Cancer valueset (2.16.840.1.113883.3.526.3.451)

Diagnosis: Condition/Diagnosis/Problem represents a practitioner’s identification of a patient’s disease, illness, injury, or condition. This category contains a single datatype to represent all of these concepts: Diagnosis. A practitioner determines the diagnosis by means of examination, diagnostic test results, patient history, and/or family history. Diagnoses are usually considered unfavorable, but may also represent neutral or favorable conditions that affect a patient’s plan of care (e.g., pregnancy). The QDM does not prescribe the source of diagnosis data in the EHR. Diagnoses may be found in a patient’s problem list, encounter diagnosis list, claims data, or other sources within the EHR. The preferred terminology for diagnoses is SNOMED-CT, but diagnoses may also be encoded using ICD-9/10. The Diagnosis datatype should not be used for differential diagnoses or rule-out diagnoses (neither of which are currently supported by the QDM).

DataType

Cardinality

PainRelatedToProstateCancerDiagnosis

0..*

BoneScanPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Bone Scan

DiagnosticStudyPerformed: Data elements that meet criteria using this datatype should document the completion of the diagnostic study indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – when the diagnostic study is initiated stopTime – when the diagnostic study is completed Examples: 1) Initiation of a treadmill stress test to the time the treadmill stress test has completed. 2) Initiation of the ultrasound study until completion of the ultrasound study

DataType

Cardinality

BoneScanPerformed

0..*

GleasonScoreInSpecimenQualitativePerformed

LaboratoryTestPerformed: Data elements that meet criteria using this datatype should document the laboratory test indicated by the QDM category and its corresponding value set was performed. Timing: The Relevant Period addresses: startTime – When the laboratory test is initiated (i.e., the time the specimen collection begins). stopTime – when the laboratory test is completed (i.e., the time the specimen collection ends). Examples: 1) Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – basically a single point in time for many specimen collections. 2) Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection Note – the time that the result report is available is a separate attribute than the time of the study (specimen collection)

DataType

Cardinality

GleasonScoreInSpecimenQualitativePerformed

0..*

ProstateSpecificAntigenTestPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Prostate Specific Antigen Test

LaboratoryTestPerformed: Data elements that meet criteria using this datatype should document the laboratory test indicated by the QDM category and its corresponding value set was performed. Timing: The Relevant Period addresses: startTime – When the laboratory test is initiated (i.e., the time the specimen collection begins). stopTime – when the laboratory test is completed (i.e., the time the specimen collection ends). Examples: 1) Initiation of a venipuncture for a fasting blood glucose to the time venipuncture for the fasting blood glucose is completed – basically a single point in time for many specimen collections. 2) Initiation of a 24-hour urine collection for measured creatinine clearance until completion of the 24-hour urine collection Note – the time that the result report is available is a separate attribute than the time of the study (specimen collection)

DataType

Cardinality

ProstateSpecificAntigenTestPerformed

0..*

EthnicityPatientCharacteristicEthnicity

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Ethnicity valueset (2.16.840.1.114222.4.11.837)

PatientCharacteristicEthnicity: Data elements that meet criteria using this datatype should document that the patient has one or more of the ethnicities indicated by the QDM category and its corresponding value set. Timing: Ethnicity does not have a specific timing. Measures using Patient Characteristic, Ethnicity should address the most recent entry in the clinical record.

DataType

Cardinality

EthnicityPatientCharacteristicEthnicity

0..*

OncAdministrativeSexPatientCharacteristicGender

Clinical Focus: Gender identity restricted to only Male and Female used in administrative situations requiring a restriction to these two categories.

Data Element Scope: Gender

Inclusion Criteria: Male and Female only.

Exclusion Criteria: Any gender identity that is not male or female.

ResultValue constrained to codes in the ONC Administrative Sex valueset (2.16.840.1.113762.1.4.1)

PatientCharacteristicGender: Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set. Timing: Birth (administrative) sex does not have a specific timing.

DataType

Cardinality

OncAdministrativeSexPatientCharacteristicGender

0..*

MalePatientCharacteristicGender

Clinical Focus: Concepts that represent Male when assessing quality measures

Data Element Scope: Gender

Inclusion Criteria: Appropriate male gender concepts

Exclusion Criteria: concepts representing Female gender

ResultValue constrained to codes in the Male valueset (2.16.840.1.113883.3.560.100.1)

PatientCharacteristicGender: Data elements that meet criteria using this datatype should document that the patient's sex matches the QDM category and its corresponding value set. Timing: Birth (administrative) sex does not have a specific timing.

DataType

Cardinality

MalePatientCharacteristicGender

0..*

PayerPatientCharacteristicPayer

Clinical Focus: Categories of types of health care payor entities as defined by the US Public Health Data Consortium SOP code system

Data Element Scope: @code in CCDA r2.1 template Planned Coverage [act: identifier urn:oid:2.16.840.1.113883.10.20.22.4.129 (open)] DYNAMIC

Inclusion Criteria: All codes in the code system

Exclusion Criteria: none

ResultValue constrained to codes in the Payer valueset (2.16.840.1.114222.4.11.3591)

PatientCharacteristicPayer: Data elements that meet criteria using this datatype should document that the patient has one or more of the payers indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: startTime – The first day of insurance coverage with the referenced payer stopTime – The last day of insurance coverage with the referenced payer

DataType

Cardinality

PayerPatientCharacteristicPayer

0..*

RacePatientCharacteristicRace

Clinical Focus:

Data Element Scope:

Inclusion Criteria:

Exclusion Criteria:

ResultValue constrained to codes in the Race valueset (2.16.840.1.114222.4.11.836)

PatientCharacteristicRace: Data elements that meet criteria using this datatype should document the patient’s race. Timing: Race does not have a specific timing. Measures using Patient Characteristic, Race should address the most recent entry in the clinical record.

DataType

Cardinality

RacePatientCharacteristicRace

0..*

CancerStagingPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Cancer Staging

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

CancerStagingPerformed

0..*

ProstateCancerTreatmentPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Prostate Cancer Treatment

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

ProstateCancerTreatmentPerformed

0..*

SalvageTherapyPerformed

Clinical Focus: Under Development

Data Element Scope: Under Development

Inclusion Criteria: Under Development

Exclusion Criteria: Under Development

Subject constrained to the Salvage Therapy

ProcedurePerformed: Data elements that meet criteria using this datatype should document the completion of the procedure indicated by the QDM category and its corresponding value set. Timing: The Relevant Period addresses: StartTime = the time the procedure begins; StopTime = the time the procedure is completed NOTE: 1) Timing refers to a single instance of a procedure. If a measure seeks to evaluate multiple procedures over a period of time, the measure developer should use CQL logic to represent the query request. 2) The Incision dateTime is a single point in time available from the Operating Room and/or Anesthesia Record.

DataType

Cardinality

SalvageTherapyPerformed

0..*