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## Complete Summary

#### TITLE

Oncology: percentage of patients, regardless of age, with a diagnosis of
breast, colon, or rectal cancer who are seen in the ambulatory setting
who have a baseline AJCC cancer stage or documentation that the cancer
is metastatic in the medical record at least once during the 12 month
reporting period.

#### SOURCE(S)

American Society for Therapeutic Radiology and Oncology, American
Society of Clinical Oncology, Physician Consortium for Performance
Improvement®. Oncology physician performance measurement set. Chicago
(IL): American Medical Association (AMA); 2008 Jun. 48 p. \[16
references\]

### 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 percentage of patients, regardless of
age, with a diagnosis of breast, colon, or rectal cancer who are seen in
the ambulatory setting who have a baseline American Joint Committee on
Cancer (AJCC) cancer stage or documentation that the cancer is
metastatic in the medical record at least once during the 12 month
reporting period.

#### RATIONALE

Cancer stage is a critical component in determining treatment options
for patients with cancer. Though critically important, cancer stage is
not always documented in the medical record.\*

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

A simple classification scheme, which can be incorporated into a form
for staging and can be universally applied, is the goal of the TNM
system as proposed by the American Joint Committee on Cancer (AJCC).
Thus, examination during the surgical procedure and histologic
examination of the surgically removed tissues may identify significant
additional indicators of the prognosis of the patient (T, N, and M) as
different from what could be discerned clinically before therapy.
Because this is that pathologic (pTNM) classification and stage grouping
(based on examination of a surgically resected specimen with sufficient
tissue to evaluate the highest T, N, or M classification), it is
recorded in addition to the clinical classification. It does not replace
the clinical classification. Both should be maintained in the patient\'s
permanent medical record\... It is intended to provide a means by which
this information can readily be communicated to others, to assist in
therapeutic decisions, and to help estimate prognosis. (Joint Committee
on Cancer 2002)

A central component of the treatment of breast cancer is full knowledge
of extent of disease and biological features. The need for and selection
of various local or systemic therapies are based on a number of
prognostic and predictive factors. These factors include tumor
histology, clinical and pathologic characteristics of the primary tumor,
axillary node status, tumor hormone receptor content, tumor HER2 status,
presence or absence of detectable metastatic disease, patient comorbid
conditions, patient age, and menopausal status. (National Comprehensive
Cancer Network \[NCCN\] 2007)

#### PRIMARY CLINICAL COMPONENT

Breast cancer; colon cancer; rectal cancer; American Joint Committee on
Cancer (AJCC) cancer stage (Tumor, Lymph Node, Metastasis \[TNM\]
system)

#### DENOMINATOR DESCRIPTION

All patients, regardless of age, with a diagnosis of breast, colon, or
rectal cancer who are seen in the ambulatory setting

#### NUMERATOR DESCRIPTION

Patients who have a baseline American Joint Committee on Cancer (AJCC)
cancer stage\* or documentation that the cancer is metastatic in the
medical record at least once during the 12 month reporting period

\*Cancer stage refers to stage at diagnosis.

### 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

#### PROFESSIONALS RESPONSIBLE FOR HEALTH CARE

Physicians

#### LOWEST LEVEL OF HEALTH CARE DELIVERY ADDRESSED

Individual Clinicians

#### TARGET POPULATION AGE

All patients, regardless of age

#### 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

Getting Better\
Living with Illness

#### IOM DOMAIN

Effectiveness

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients, regardless of age, with a diagnosis of breast, colon, or
rectal cancer who are seen in the ambulatory setting

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients, regardless of age, with a diagnosis of breast, colon, or
rectal cancer who are seen in the ambulatory setting

**Exclusions**\
None

#### 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 who have a baseline American Joint Committee on Cancer (AJCC)
cancer stage\* or documentation that the cancer is metastatic in the
medical record at least once during the 12 month reporting period

\*Cancer stage refers to stage at 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

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 #1: cancer stage documented.

#### MEASURE COLLECTION

[The Physician Consortium for Performance Improvement® Measurement
Sets](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2003&doc=178)

#### MEASURE SET NAME

[Oncology Physician Performance Measurement
Set](http://www.qualitymeasures.ahrq.gov/Browse/DisplayOrganization.aspx?org_id=2003&doc=12049)

#### SUBMITTER

American Medical Association on behalf of the American Society for
Therapeutic Radiology and Oncology, the American Society of Clinical
Oncology, and the Physician Consortium for Performance Improvement®

#### DEVELOPER

American Society for Therapeutic Radiology and Oncology\
American Society of Clinical Oncology\
Physician Consortium for Performance Improvement®

#### FUNDING SOURCE(S)

Unspecified

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

Patricia Ganz, MD (*Co-Chair*); James Hayman, MD (*Co-Chair*); Joseph
Bailes, MD; Nancy Baxter, MD, PhD; Joel V. Brill, MD; Steven B. Clauser,
PhD; Charles Cleeland, PhD; J. Thomas Cross, Jr. MD, MPH; Chaitanya R.
Divgi, MD; Stephen B. Edge, MD; Patrick L. Fitzgibbons, MD; Sue
Frechette; Myron Goldsmith, MD; Joel W. Goldwein, MD; Alecia Hathaway,
MD, MPH; Kevin P. Hubbard, DO; Nora Janjan, MD, MPSA; Maria Kelly, MB,
BCh; Wayne Koch, MD; Andre Konski, MD; Len Lichtenfeld, MD; Norman J.
Marcus, MD; Catherine Miyamoto, RN, BSN; Michael Neuss, MD; Jean Owen,
PhD; David F. Penson, MD, MPH; Louis Potters, MD; John M. Rainey, MD;
Christopher M. Rose, MD; Lee Smith, MD; Lawrence A. Solberg, MD, PhD;
Paul E. Wallner, MD; J. Frank Wilson, MD; Rodger Winn, MD

*American Society for Therapeutic Radiation and Oncology*: Dave Adler;
Robyn Watson, PhD; Emily Wilson

*American Society of Clinical Oncologists*: Pamela Kadlubek, MPH;
Kristen McNiff, MPH; Julia Tompkins

*American College of Radiation Oncology*: Jennifer Dreyfus

*American College of Surgeons*: Julie Lewis

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

*Centers for Medicare & Medicaid Service*: Tiffany Sanders, MD

*College of American Pathologists Staff*: Fay Shamanski, PhD

*Consumer Representative*: Catherine D. Harvey, Dr.PH

*Health Plan Representative*: Ranae Dahlberg

*Consortium Consultant*: Rebecca Kresowik; Timothy Kresowik, MD

*National Committee for Quality Assurance*: Donna Pillittere

*National Comprehensive Cancer Network*: Joan McClure, MS

#### 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

#### ADAPTATION

Measure was not adapted from another source.

#### RELEASE DATE

2007 Oct

#### REVISION DATE

2008 Jun

#### MEASURE STATUS

This is the current release of the measure.

#### SOURCE(S)

American Society for Therapeutic Radiology and Oncology, American
Society of Clinical Oncology, Physician Consortium for Performance
Improvement®. Oncology physician performance measurement set. Chicago
(IL): American Medical Association (AMA); 2008 Jun. 48 p. \[16
references\]

#### MEASURE AVAILABILITY

The individual measure, \"Measure #1: Cancer Stage Documented,\" is
published in the \"Oncology 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 8, 2008.
The information was verified by the measure developer on October 16,
2008.

#### COPYRIGHT STATEMENT

© 2007 American Medical Association and American Society of CLinical
Oncology. All Rights Reserved.

CPT® Copyright 2006 American Medical Association

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/17/2008