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## Complete Summary

#### TITLE

Melanoma: percentage of patients with stage 0 or IA melanoma, without
signs or symptoms, for whom no diagnostic imaging studies were ordered.

#### SOURCE(S)

American Academy of Dermatology, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Melanoma II
physician performance measurement set. Chicago (IL): American Medical
Association, National Committee for Quality Assurance; 2007 Oct. 23 p.
\[5 references\]

### 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 with stage 0
or IA melanoma, without signs or symptoms, for whom no diagnostic
imaging studies were ordered.

#### RATIONALE

There is no valid indication for expensive imaging studies in early
stage melanoma in the absence of signs or symptoms. There is a
perception that radiologic studies are being administered for grade 0
and grade I melanoma that are clinically unnecessary and create economic
burden to the patient and payer. While diagnostic imaging is also
inappropriate for patients with higher stages of melanoma as well, this
measure is a first step in addressing the over-utilization of diagnostic
imaging studies in patients with melanoma.\*

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

The panel unanimously agreed that no specific search for occult visceral
metastases, with either chest x-ray or blood work, is necessary in
patients with 0 and IA melanoma. This National Comprehensive Cancer
Network (NCCN) recommendation is consistent with the National Institutes
of Health (NIH) consensus guidelines. Imaging studies such as computed
tomography (CT) scan, positron emission tomography (PET), and/or
magnetic resonance imaging (MRI) may be performed for all patients to
evaluate specific signs or symptoms. For patients with IB-II melanomas,
a baseline chest x-ray is optional because this test in insensitive for
detecting clinically occult distant disease in the lungs. (NCCN)

No investigations are necessary for patients with stage I disease. Stage
I and IIA melanoma patients should not be staged by imaging, as the
true-positive pick-up rate is low and the false-positive rate is high.
Patients at intermediate or high risk of recurrent disease (stage IIB
and over) should have the following staging investigations: chest x-ray;
liver ultrasound or CT scan with contrast of the chest, abdomen +
pelvis; liver function tests/lactate dehyrdogenase; and full blood
count. In the absence of effective chemotherapy for melanoma, however,
it may be reasonable to omit scanning in individual stage IIB patients.
There is no place for a bone scan in staging except where symptoms point
to possible bone disease. (National Institute for Health and Clinical
Excellence \[NICE\])

#### PRIMARY CLINICAL COMPONENT

Stage 0 melanoma; stage 1A melanoma; chest x-ray; computed tomography
(CT) scan; ultrasound; magnetic resonance imaging (MRI); positron
emission tomography (PET); nuclear medicine scans

#### DENOMINATOR DESCRIPTION

All patients with stage 0 or IA melanoma (see the related \"Denominator
Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients with stage 0 or IA melanoma, without signs or symptoms, for
whom no diagnostic imaging studies were ordered (see the related
\"Numerator Inclusions/Exclusions\" field in the Complete Summary)

### Evidence Supporting the Measure

#### EVIDENCE SUPPORTING THE CRITERION OF QUALITY

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

### 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

### Application of Measure in its Current Use

#### CARE SETTING

Ambulatory Care\
Physician Group Practices/Clinics

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

Patients of all ages are included in this measure

#### 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\
Patient-centeredness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients with stage 0 or IA melanoma

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients with stage 0 or IA melanoma

Refer to the original measure documentation for administrative codes.

**Exclusions**

-   \"Documentation of medical reason(s) for ordering diagnostic imaging
    studies (e.g., patient has signs or symptoms that justify imaging
    studies)

-   Documentation of system reason(s) for ordering diagnostic imaging
    studies (e.g., requirement for clinical trial enrollment, ordered by
    another provider)

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Encounter

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients with stage 0 or IA melanoma, without signs or symptoms, for
whom no diagnostic imaging studies\* were ordered

\*Diagnostic imaging studies include chest x-ray, computed tomography
(CT) scan, ultrasound, magnetic resonance imaging (MRI), positron
emission tomography (PET), and nuclear medicine scans.

Refer to the original measure documentation for administrative codes.

**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

Fixed time period

#### 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 #4: over utilization of imaging studies in stage 0-IA melanoma.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2000&doc=178)

#### MEASURE SET NAME

[Melanoma Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2000&doc=10265)

#### SUBMITTER

American Medical Association on behalf of the American Academy of
Dermatology, the Physician Consortium for Performance Improvement®, and
the National Committee for Quality Assurance (NCQA)

#### DEVELOPER

American Academy of Dermatology\
National Committee for Quality Assurance\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

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

Dirk Elston, MD (*Co-Chair*); Raj Behal, MD, MPH (*Co-Chair*); Steven D.
Bines, MD; Peter Dandalides, MD; Evan R. Farmer, MD; Rutledge Fourney,
MD; Andrea Gelzer, MD, MS, FACP; Robert T. Gilson, MD; Stephen E. Helms,
MD; Abrar Qureshi, MD; Todd Schlessinger, MD; John Schneider, MD, PhD;
Arthur Joel Sober, MD; Steven W. Strode, MD, MEd, MPH; Janet (Jessie)
Sullivan, MD; William Wooden, MD

Sandra Peters, MHA, American Academy of Dermatology; Carol Sieck, RN,
MSN, American Academy of Dermatology

Joseph Gave, MPH, American Medical Association; Kendra Hanley, MS, CHE,
American Medical Association; Erin O. Kaleba, MPH, American Medical
Association; Karen S. Kmetik, PhD, American Medical Association

Phil Renner, MBA, National Committee for Quality Assurance

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

Rebecca A. Kresowik, Facilitator; Timothy F. Kresowik, MD, Facilitator

#### 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.

#### INCLUDED IN

Ambulatory Care Quality Alliance

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Oct

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Academy of Dermatology, Physician Consortium for Performance
Improvement®, National Committee for Quality Assurance. Melanoma II
physician performance measurement set. Chicago (IL): American Medical
Association, National Committee for Quality Assurance; 2007 Oct. 23 p.
\[5 references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #4: Over Utilization of Imaging
Studies in Stage 0-IA Melanoma,\" is published in the \"Melanoma
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 October 2, 2007.
The information was verified by the measure developer on November 21,
2007.

#### COPYRIGHT STATEMENT

© Measures including specifications

© 2007 American Medical Association and National Committee for Quality
Assurance

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008