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## Complete Summary

#### TITLE

Hematology: percentage of patients aged 18 years and older with a
diagnosis of myelodysplastic syndrome (MDS) who are receiving
erythropoietin therapy with documentation of iron stores prior to
initiating erythropoietin therapy.

#### 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) who are
receiving erythropoietin therapy with documentation of iron stores prior
to initiating erythropoietin therapy.

#### RATIONALE

To be effective erythropoietin requires that adequate iron stores be
present due to iron\'s importance in red-blood cell synthesis. Iron
deficiency presents a major limitation to the efficacy of erythropoietin
therapy.\*

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

Anemia related to myelodysplastic syndrome (MDS) generally presents as a
hypoproductive macrocytic anemia, often associated with suboptimal
elevation of serum Epo levels. Iron repletion needs to be verified
before instituting Epo therapy. (National Comprehensive Cancer Network
\[NCCN\])

#### PRIMARY CLINICAL COMPONENT

Myelodysplastic syndrome (MDS); erythropoietin therapy; iron stores
(bone marrow examination, ferritin, serum iron, total iron binding
capacity \[TIBC\])

#### DENOMINATOR DESCRIPTION

All patients aged 18 years and older with a diagnosis of myelodysplastic
syndrome (MDS) who are receiving erythropoietin therapy (see the related
\"Denominator Inclusions/Exclusions\" field in the Complete Summary)

#### NUMERATOR DESCRIPTION

Patients with documentation\* of iron stores prior to initiating
erythropoietin therapy

\*Documentation includes either bone marrow examination including iron
stain OR serum iron measurement by ferritin or serum iron and total iron
binding capacity (TIBC).

### 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\
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) who are receiving erythropoietin therapy

#### 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) who are receiving erythropoietin therapy\*

\*\*Erythropoietin therapy includes the following medications: epoetin
and darbepoetin.

**Exclusions**\
Documentation of system reason(s) for not documenting iron stores prior
to initiating erythropoietin therapy

#### RELATIONSHIP OF DENOMINATOR TO NUMERATOR

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

#### DENOMINATOR (INDEX) EVENT 

Clinical Condition\
Therapeutic Intervention

#### DENOMINATOR TIME WINDOW

Time window is a single point in time

#### NUMERATOR INCLUSIONS/EXCLUSIONS

**Inclusions**\
Patients with documentation\* of iron stores prior to initiating
erythropoietin therapy

\*Documentation includes either bone marrow examination including iron
stain OR serum iron measurement by ferritin or serum iron and total iron
binding capacity (TIBC).

**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 #2: MDS - documentation of iron stores in patients receiving
erythropoietin therapy.

#### 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 #2: MDS - Documentation of Iron Stores
in Patients Receiving Erythropoietin Therapy,\" 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.

### Disclaimer

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© 2008 National Quality Measures Clearinghouse

Date Modified: 11/3/2008