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## Complete Summary

#### TITLE

Hematology: percentage of patients aged 18 years and older with a
diagnosis of myelodysplastic syndrome (MDS) or an acute leukemia who had
baseline cytogenetic testing performed on bone marrow.

#### SOURCE(S)

American Society of Hematology, Physician Consortium for Performance
Improvement®. Hematology physician performance measurement set. Chicago
(IL): American Medical Association (AMA); 2007 Jan. 22 p. \[10
references\]

### Measure Domain

#### PRIMARY MEASURE DOMAIN

Process

The validity of measures depends on how they are built. By examining the
key building blocks of a measure, you can assess its validity for your
purpose. For more information, visit the [Measure
Validity](http://www.qualitymeasures.ahrq.gov/resources/measure_domains.aspx)
page.

#### SECONDARY MEASURE DOMAIN

Does not apply to this measure

### Brief Abstract

#### DESCRIPTION

This measure is used to assess the percentage of patients aged 18 years
and older with a diagnosis of myelodysplastic syndrome (MDS) or an acute
leukemia who had baseline cytogenic testing performed on bone marrow.

#### RATIONALE

*For myelodysplastic syndrome (MDS)*:

Cytogenetic testing is an integral component in calculating the
International Prognostic Scoring System (IPSS) score. Cytogenetic
testing should be performed on the bone marrow of patients with MDS in
order to guide treatment options, determine prognosis, and predict the
likelihood of disease evolution to leukemia.\*

*For acute leukemias*:

In addition to establishing the type of acute leukemia, cytogenetic
testing is essential to detect chromosomal abnormalities that have
diagnostic, prognostic, and therapeutic significance.\*\*

The following clinical recommendation statements are quoted
[verbatim]{.underline} from the referenced clinical guidelines and
represent the evidence base for the measure:

\**For MDS*:\
Bone marrow aspiration and biopsy are needed to calculate the degree of
hematopoietic cell maturation abnormalities and relative proportions,
percentage of marrow blasts, marrow cellularity, presence or absence of
ringed sideroblasts (and presence of iron per se), and fibrosis. Marrow
cytogenetics should be obtained because they are of major importance for
prognosis. (National Comprehensive Cancer Network \[NCCN\])

The decision to treat patients having marrow blasts in the range of 20%
to 30% with intensive AML therapy is thus complex and should be
individualized. The clinician should consider such factors as age,
antecedent factors, cytogenetics, comorbidities, pace of disease, and
performance status. (NCCN)

A chromosome abnormality confirms the presence of a clonal disorder
aiding the distinction between MDS and reactive causes of dysplasia, and
in addition has major prognostic value. Cytogenetic analysis should
therefore be performed for all patients in whom a bone marrow
examination is indicated. (British Committee for Standards in
Haematology \[BCSH\])

\*\**For acute leukemias*:\
The initial evaluation has two objectives. The first is to identify the
pathology causing the disease including factors such as prior toxic
exposure or myelodysplasia, cytogenetics and molecular markers that may
have an impact on chemoresponsiveness and propensity for relapse which
may guide choice of treatment. The second objective focuses on
patient-specific factors including comorbid conditions that may affect
an individual\'s ability to tolerate chemotherapy. (NCCN)

Although cytogenetic information is usually unknown when treatment is
initiated in patients with de novo AML, karyotype represents the single
most important prognostic factor for predicting remission rate, relapse,
and overall survival. Therefore, the importance of obtaining sufficient
samples of marrow or peripheral blood blasts at diagnosis for this
analysis cannot be overemphasized. (NCCN)

#### PRIMARY CLINICAL COMPONENT

Myelodysplastic syndrome (MDS); acute leukemia; cytogenetic testing;
bone marrow

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with a diagnosis of myelodysplastic
syndrome (MDS) or an acute leukemia (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary

#### NUMERATOR DESCRIPTION

Patients who had baseline cytogenetic testing\* performed on bone marrow

\*Baseline cytogenetic testing refers to testing that is performed at
time of diagnosis or prior to initiating treatment for that diagnosis.

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

-   A clinical practice guideline or other peer-reviewed synthesis of
    the clinical evidence

#### NATIONAL GUIDELINE CLEARINGHOUSE LINK

-   [Guidelines for the diagnosis and therapy of adult myelodysplastic
    syndromes.](http://www.guideline.gov/summary/summary.aspx?ss=15&doc_id=9575)

### Evidence Supporting Need for the Measure

#### NEED FOR THE MEASURE

Unspecified

### State of Use of the Measure

#### STATE OF USE

Current routine use

#### CURRENT USE

Internal quality improvement\
National reporting

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Advanced Practice Nurses\
Physician Assistants\
Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Age greater than or equal to 18 years

#### TARGET POPULATION GENDER

Either male or female

#### STRATIFICATION BY VULNERABLE POPULATIONS

Unspecified

### Characteristics of the Primary Clinical Component

#### INCIDENCE/PREVALENCE

Unspecified

#### ASSOCIATION WITH VULNERABLE POPULATIONS

Unspecified

#### BURDEN OF ILLNESS

Unspecified

#### UTILIZATION

Unspecified

#### COSTS

Unspecified

### Institute of Medicine National Healthcare Quality Report Categories

#### IOM CARE NEED

Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients aged 18 years and older with a diagnosis of myelodysplastic
syndrome (MDS) or an acute leukemia

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients aged 18 years and older with a diagnosis of myelodysplastic
syndrome (MDS) or an acute leukemia

**Exclusions**

-   Documentation of medical reason(s) for not performing baseline
    cytogenetic testing

-   Documentation of patient reason(s) for not performing baseline
    cytogenetic testing

-   Documentation of system reason(s) for not performing baseline
    cytogenetic testing

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

All cases in the denominator are equally eligible to appear in the
numerator

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients who had baseline cytogenetic testing\* performed on bone marrow

\*Baseline cytogenetic testing refers to testing that is performed at
time of diagnosis or prior to initiating treatment for that diagnosis.

**Exclusions**\
None

#### MEASURE RESULTS UNDER CONTROL OF HEALTH CARE PROFESSIONALS, ORGANIZATIONS AND/OR POLICYMAKERS

The measure results are somewhat or substantially under the control of
the health care professionals, organizations and/or policymakers to whom
the measure applies.

#### NUMERATOR TIME WINDOW

Episode of care

#### DATA SOURCE

Administrative data\
Medical record

#### LEVEL OF DETERMINATION OF QUALITY

Individual Case

#### PRE-EXISTING INSTRUMENT USED

Unspecified

### Computation of the Measure

#### SCORING

Rate

#### INTERPRETATION OF SCORE

Better quality is associated with a higher score

#### ALLOWANCE FOR PATIENT FACTORS

Unspecified

#### STANDARD OF COMPARISON

Internal time comparison

### Evaluation of Measure Properties

#### EXTENT OF MEASURE TESTING

Unspecified

### Identifying Information

#### ORIGINAL TITLE

Measure #1: MDS and acute leukemias - baseline cytogenetic testing
performed on bone marrow.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1943&doc=178)

#### MEASURE SET NAME

[Hematology Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=1943&doc=10743)

#### SUBMITTER

American Medical Association on behalf of the American Society of
Hematology and the Physician Consortium for Performance Improvement®

#### DEVELOPER

American Society of Hematology\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

#### COMPOSITION OF THE GROUP THAT DEVELOPED THE MEASURE

Steven L. Allen, MD (*Co-Chair*); William E. Golden, MD (*Co-Chair*);
Kenneth Adler, MD; Daniel Halevy, MD; Stuart Henochowicz, MD, MBA;
Timothy Miley, MD; David Morris, MD; John M. Rainey, MD; Samuel M.
Silver, MD, PhD; Lawrence Solberg, Jr., MD, PhD

Mila Becker, Esq., American Society of Hematology; Pamela Ferraro, MS,
American Society of Hematology; Sue Frechette, BSN, MBA (Consultant),
American Society of Hematology

Karen S. Kmetik, PhD, American Medical Association; Samantha Tierney,
MPH, American Medical Association

Kristen McNiff, MPH, American Society of Clinical Oncology

Emily Wilson, American Society for Therapeutic Radiology and Oncology

Hildy Dillon, MPH, Leukemia and Lymphoma Society; Mary Grace Pagaduan,
MPH, Leukemia and Lymphoma Society

Sue Nedza, MD, MBA, FACEP, Centers for Medicare & Medicaid Services;
Sylvia Publ, MBA, RHIA, Centers for Medicare & Medicaid Services

Rebecca Kresowik, Consortium Consultant; Timothy F. Kresowik, MD,
Consortium Consultant

#### FINANCIAL DISCLOSURES/OTHER POTENTIAL CONFLICTS OF INTEREST

Conflicts, if any, are disclosed in accordance with the Physician
Consortium for Performance Improvement® conflict of interest policy.

#### ENDORSER

National Quality Forum

#### INCLUDED IN

Ambulatory Care Quality Alliance\
Physician Quality Reporting Initiative

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Jan

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Society of Hematology, Physician Consortium for Performance
Improvement®. Hematology physician performance measurement set. Chicago
(IL): American Medical Association (AMA); 2007 Jan. 22 p. \[10
references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #1: MDS and Acute Leukemias - Baseline
Cytogenetic Testing Performed on Bone Marrow,\" is published in the
\"Hematology Physician Performance Measurement Set.\" This document and
technical specifications are available in Portable Document Format (PDF)
from the American Medical Association (AMA)-convened Physician
Consortium for Performance Improvement® Web site:
[www.physicianconsortium.org](http://www.physicianconsortium.org/).

For further information, please contact AMA staff by e-mail at
<cqi@ama-assn.org>.

#### NQMC STATUS

This NQMC summary was completed by ECRI Institute on September 13, 2007.
The information was verified by the measure developer on October 26,
2007.

#### COPYRIGHT STATEMENT

© Copyright 2006-7 American Medical Association and American Society of
Hematology. All Rights Reserved.

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008