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## Complete Summary

#### TITLE

Melanoma: percentage of patients with a new diagnosis of melanoma or a
history of melanoma who received all of the following aspects of care
within the 12 month reporting period: (1) patient was asked about new
and changing moles AND (2) patient received a complete physical skin
examination AND (3) patient was counseled to perform a monthly self skin
examination.

#### 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 a new
diagnosis of melanoma or a history of melanoma who received all of the
following aspects of care within the 12 month reporting period: (1)
Patient was asked about new and changing moles AND (2) Patient received
a complete physical skin examination AND (3) Patient was counseled to
perform a monthly self skin examination.

#### RATIONALE

Early detection of an additional or secondary primary melanoma is an
important goal of follow-up care. The majority of additional primary
melanomas are discovered by the patient or family member. Educating
patients to perform self-examinations will lead to earlier detection of
secondary primary sites of melanoma. Only 60% of physicians routinely
perform full-body examinations with their high-risk patients.\*

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

Skin examination and surveillance at least once a year for life is
recommended for all melanoma patients, including those with stage 0 in
situ-melanoma. Frequency of dermatologic surveillance should be
determined individually, based on risk factors, including skin type,
family history, presence of dysplastic nevi, and history of non-melanoma
skin cancers. Clinicians should also consider educating patients about
monthly self-exam of their skin and lymph nodes. (National Comprehensive
Cancer Network \[NCCN\])

For patients with stage IA melanoma, a comprehensive H&P (with specific
emphasis on the regional nodes and skin) should be performed every 3 to
12 months as clinically indicated. For patients with stage IB-III
melanomas, a comprehensive H&P (with emphasis on the regional nodes and
skin) should be performed every 3 to 6 months for 3 years; then every 4
to 12 months for 2 years; and annually (at least) thereafter, as
clinically indicated. (NCCN)

A structured follow-up program could permit the earlier detection of
recurrent disease at a time when it might be more amenable to
potentially curative surgical resection. This follow-up would be
particularly appropriate for patients at risk for regional nodal
recurrence who have not yet undergone sentinel node biopsy or elective
lymph node dissection. (NCCN)

All patients should be taught self-examination because many recurrences
are found by patients themselves at home rather than by clinicians in
the clinic. (British Association of Dermatologists \[BAD\])

#### PRIMARY CLINICAL COMPONENT

Melanoma; cutaneous melanoma; medical history; moles; complete physical
skin examination; self-skin examination

#### DENOMINATOR DESCRIPTION

All patients with a new diagnosis of melanoma or a history of melanoma
(see the related \"Denominator Inclusions/Exclusions\" field in the
Complete Summary)

#### NUMERATOR DESCRIPTION

Patients who received all of the following aspects of care at least once
within the 12 month reporting period: (1) Patient was asked specifically
if he/she had any new or changing moles AND (2) A complete physical skin
examination was performed and the morphology, size, and location of new
or changing pigmented lesions were noted AND (3) patient was counseled
to perform a monthly self skin examination (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

Use of this measure to improve performance

#### EVIDENCE SUPPORTING NEED FOR THE MEASURE

Geller AC, O\'Riordan DL, Oliveria SA, Valvo S, Teich M, Halpern AC.
Overcoming obstacles to skin cancer examinations and prevention
counseling for high-risk patients: results of a national survey of
primary care physicians. J Am Board Fam Pract2004 Nov-Dec;17(6):416-23.
[PubMed](http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=pubmed&dopt=Abstract&list_uids=15575033)

### 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

### Data Collection for the Measure

#### CASE FINDING

Users of care only

#### DESCRIPTION OF CASE FINDING

All patients with a new diagnosis of melanoma or a history of melanoma

#### DENOMINATOR SAMPLING FRAME

Patients associated with provider

#### DENOMINATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
All patients with a new diagnosis of melanoma or a history of cutaneous
melanoma

Refer to the original measure documentation for administrative codes.

**Exclusions**\
Documentation of system reason(s) for not performing the follow-up
services (e.g., another physician performed the service)

#### 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 received all of the following aspects of care at least once
within the 12 month reporting period: (1) Patient was asked specifically
if he/she had any new or changing moles AND (2) A complete physical skin
examination\* was performed and the morphology, size, and location of
new or changing pigmented lesions were noted AND (3) patient was
counseled to perform a monthly self skin examination

\*A complete physical skin examination includes: head (including the
face), neck, chest (including the axillae), abdomen, back, and
extremities. The genitalia (including the groin and buttocks) may also
be examined (optional).

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 #1: melanoma follow-up measures.

#### 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 #1: Melanoma Follow-Up Measures,\" is
published in the \"Melanoma II 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