Quality Measure Implementation Guide

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v0.1.0: STU 1 Ballot 1) based on FHIR R3. The current version which supercedes this version is 3.0.0. For a full list of available versions, see the Directory of published versions

Measure-measure-exm124-FHIR

Formats: XML, JSON, Turtle

Id: Measure/measure-exm124-FHIR
Type:
system: http://hl7.org/fhir/measure-type
code: process
Identifier: system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/cms
value: 130
system: http://hl7.org/fhir/cqi/ecqm/Measure/Identifier/nqf
value: 0034
Title: Cervical Cancer Screening
Status: active
Description: Percentage of women 21-64 years of age who were screened for cervical cancer using either of the following criteria: <br> * Women age 21-64 who had cervical cytology performed every 3 years <br.* Women age 30-64 who had cervical cytology/human papillomavirus (HPV) co-testing performed every 5 years
Purpose: Women 23-64 years of age with a visit during the measurement period
Use Context:

code: program

value:
text: eligible-provider

Topic:
system: http://loinc.org
code: 57024-2
display: Health Quality Measure Document
Contributor: author: National Committee for Quality Assurance
Related:

type: citation

citation:
Howlader, N., Noone, A.M., Krapcho, M., Miller, D., Bishop, K., Altekruse, S.F., Kosary, C.L., Yu, M., Ruhl, J., Tatalovich, Z., Mariotto, A., Lewis, D.R., Chen, H.S., Feuer, E.J., and Cronin, K.A. 2016. "SEER Cancer Statistics Review, 1975-2013." National Cancer Institute. (December 5, 2016) http://seer.cancer.gov/csr/1975_2013/

type: citation

citation:
National Business Group on Health. 2011. "Pathways to Managing Cancer in the Workplace." (May 8, 2012). http://www.tcyh.org/employers/downloads/Pathways_Managing_Cancer_2011.pdf

type: citation

citation:
Feig S. 2011. Comparison of Costs and Benefits of Breast Cancer Screening with Mammography, Ultrasonagraphy, and MRI. Obstetrics and Gynecology Clinics of North America. 38(1):179-96.

type: citation

citation:
U.S. Preventive Services Task Force (USPSTF). 2016. "Screening for Breast Cancer: U.S. Preventive Services Task Force Recommendation Statement." Ann Intern Med. 164(4):279-296. doi:10.7326/M15-2886.

Library:

reference: Library/library-exm124-FHIR

Disclaimer: The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. <br> Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].
Scoring:
system: http://hl7.org/fhir/measure-scoring
code: proportion
Rationale: Breast cancer is one of the most common types of cancers, accounting for 15 percent of all new cancer diagnoses in the U.S. (Howlader et al, 2016). In 2013, over 3 million women were estimated to be living with breast cancer in the U.S. and it is estimated that 12 percent of women will be diagnosed with breast cancer at some point during their lifetime (Howlader et al, 2016). <br> While there are other factors that affect a woman's risk of developing breast cancer, advancing age is a primary risk factor. Breast cancer is most frequently diagnosed among women ages 55-64; the median age at diagnosis is 62 years (Howlader et al, 2016). The chance of a woman being diagnosed with breast cancer in a given year increases with age. By age 40, the chances are 1 in 235; by age 50 it becomes 1 in 54; by age 60, it is 1 in 25 (National Business Group on Health, 2011). <br> In the U.S., costs associated with a diagnosis of breast cancer range from $451 to $2,520, factoring in continued testing, multiple office visits and procedures. The total costs related to breast cancer add up to nearly $7 billion per year in the U.S., including $2 billion spent on late-stage treatment (National Business Group on Health, 2011). If breast cancer is detected through mammography screening and diagnosed in its earliest stages, treatment may be less expensive (Feig, 2011).
Clinical Recommendation: The U.S. Preventive Services Task Force (USPSTF) recommends biennial screening mammography for women aged 50-74 years (B recommendation). <br> The decision to start screening mammography in women prior to age 50 years should be an individual one. Women who place a higher value on the potential benefit than the potential harms may choose to begin biennial screening between the ages of 40 and 49 years (C recommendation). (USPSTF, 2016) <br> The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening mammography in women aged 75 years or older (I statement). (USPSTF, 2016) <br> The USPSTF concludes that the current evidence is insufficient to assess the benefits and harms of digital breast tomosynthesis (DBT) as a primary screening method for breast cancer (I Statement). (USPSTF, 2016) <br> The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of adjunctive screening for breast cancer using breast ultrasonography, magnetic resonance imaging, DBT, or other methods in women identified to have dense breasts on an otherwise negative screening mammogram (I statement). (USPSTF, 2016)
Guidance: To ensure the measure is only looking for a cervical cytology test only after a woman turns 21 years of age, the youngest age in the initial population is 23. <br> Patient self-report for procedures as well as diagnostic studies should be recorded in 'Procedure, Performed' template or 'Diagnostic Study, Performed' template in QRDA-1. <br> Include only cytology and HPV "co-testing"; in co-testing, both cytology and HPV tests are performed (i.e., the samples are collected and both tests are ordered, regardless of the cytology result) on the same date of service. Do not include reflex testing. In addition, if the medical record indicates the HPV test was performed only after determining the cytology result, this is considered reflex testing and does not meet criteria for the measure.
Group:

Identifier:
value: group-1

Population:

Identifier:
value: initial-population-identifier

criteria: Initial Population

Identifier:
value: numerator-identifier

criteria: Numerator

Identifier:
value: denominator-identifier

criteria: Denominator

Identifier:
value: denominator-exclusions-identifier

criteria: Denominator Exclusion

Supplemental Data:

Identifier:
value: sde-ethnicity

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Ethnicity

Identifier:
value: sde-payer

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Payer

Identifier:
value: sde-race

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Race

Identifier:
value: sde-sex

usage:
system: http://hl7.org/fhir/measure-data-usage
code: supplemental-data

criteria: SDE Sex