Quality Measure STU1 for FHIR STU3 Implementation Guide

This page is part of the Quality Measure STU2 for FHIR R4 Implementation Guide (v1.0.0: STU 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-exm130-FHIR

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Measure Title

Colorectal Cancer Screening

Measure ID

EXM130

Description

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

Measurement Period January 1 - December 31
Copyright and Disclaimer Notice
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. Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

This Physician Performance Measure (Measure) and related data specifications were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (eg, use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2017 National Committee for Quality Assurance. All Rights Reserved. Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2017 American Medical Association. LOINC(R) copyright 2004-2017 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R] ) copyright 2004-2017 International Health Terminology Standards Development Organisation. ICD-10 copyright 2017 World Health Organization. All Rights Reserved.
Clinical Recommendation Statement

The U. S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force 2016). Screening tests: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)

References
U.S. Preventive Services Task Force. "Screening for Colorectal Cancer: U.S. Preventive Services Task Force Recommendation Statement." JAMA, vol. 315, no. 23, 2016, pp. 2564-2575. doi: 10.1001/jama.2016.5989
Howlader, N., A.M. Noone, M. Krapcho, D. Miller, K. Bishop, C.L. Kosary, M. Yu, J. Ruhl, Z. Tatalovich, A. Mariotto, D.R. Lewis, H.S. Chen, E.J. Feuer, and K.A. Cronin. "SEER Cancer Statistics Review, 1975-2014." Washington, DC: National Cancer Institute, 2017. Available at https://seer.cancer.gov/csr/1975_2014/
American Cancer Society. "Can Colorectal Polyps and Cancer Be Found Early?" Last modified March 2017. Washington, DC: American Cancer Society. Available at https://www.cancer.org/cancer/colon-rectal-cancer/detection-diagnosis-staging/detection.html.
Characteristics
Scoring Proportion
Type Process
Improvement Notation A higher rate indicates better performance.
Guidance

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. Do not count DRE, FOBT tests performed in an office setting or performed on a sample collected via DRE.

Definitions

Table of Contents


Population Criteria

        • 	Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75]
          			and exists AdultOutpatientEncounters."Qualifying Encounters"("Measurement Period")
         
        • 	exists "Colonoscopy Performed"
          		or exists "Fecal Occult Blood Test Performed"
          		or exists "Flexible Sigmoidoscopy Performed"
          		or exists "Fecal Immunochemical Test DNA"
          		or exists "CT Colonography Performed"
         
        • 	true
         
        • 	Hospice."Has Hospice"("Measurement Period")
          		or exists "Malignant Neoplasm"
          		or exists "Total Colectomy Performed"
         

Definitions

        • 	[Procedure: "Colonoscopy"] Colonoscopy
          		where Colonoscopy.status = 'completed'
          		 	and Colonoscopy.performed ends 10 years or less on or before end of "Measurement Period"
         
        • 	[Procedure: "CT Colonography"] Colonography
          		where Colonography.status = 'completed'
          			and Colonography.performed ends 5 years or less on or before end of "Measurement Period"
         
        • 	true
         
        • 	Hospice."Has Hospice"("Measurement Period")
          		or exists "Malignant Neoplasm"
          		or exists "Total Colectomy Performed"
         
        • 	[Observation: "FIT DNA"] FitDNA
          		where FitDNA.value is not null
          			and FitDNA.effective occurs 3 years or less on or before day of end of "Measurement Period"
         
        • 	[Observation: "Fecal Occult Blood Test (FOBT)"] FecalOccultResult
          		where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'}
          			and FecalOccultResult.value is not null
          			and FecalOccultResult.effective during day of "Measurement Period"
         
        • 	[Procedure: "Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy
          		where FlexibleSigmoidoscopy.status = 'completed'
          			and FlexibleSigmoidoscopy.performed ends 5 years or less on or before end of "Measurement Period"
         
        • 	Global."CalendarAgeInYearsAt"(FHIRHelpers.ToDate(Patient.birthDate), start of "Measurement Period") in Interval[50, 75]
          			and exists AdultOutpatientEncounters."Qualifying Encounters"("Measurement Period")
         
        • 	[Condition: "Malignant Neoplasm of Colon"] ColorectalCancer
          		where Global."Normalize Onset"(ColorectalCancer.onset) starts on or before end of "Measurement Period"
         
        • 	exists "Colonoscopy Performed"
          		or exists "Fecal Occult Blood Test Performed"
          		or exists "Flexible Sigmoidoscopy Performed"
          		or exists "Fecal Immunochemical Test DNA"
          		or exists "CT Colonography Performed"
         
        •   SDE."SDE Ethnicity"
         
        •   SDE."SDE Payer"
         
        •   SDE."SDE Race"
         
        •   SDE."SDE Sex"
         
        • 	[Procedure: "Total Colectomy"] Colectomy
          		where Colectomy.status = 'completed'
          			and Global."Get Choice Interval - dateTime or Period"(Colectomy.performed) starts on or before end of "Measurement Period"
         

Functions

Terminology

  • valueset "Colonoscopy" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020'
  • valueset "CT Colonography" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038'
  • valueset "Ethnicity" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.837'
  • valueset "Fecal Occult Blood Test (FOBT)" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011'
  • valueset "FIT DNA" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039'
  • valueset "Flexible Sigmoidoscopy" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010'
  • valueset "Malignant Neoplasm of Colon" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001'
  • valueset "ONC Administrative Sex" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113762.1.4.1'
  • valueset "Payer" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591'
  • valueset "Race" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.836'
  • valueset "Total Colectomy" : 'http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019'

Data Criteria (QDM Data Elements)

  • "Condition: Malignant Neoplasm of Colon" using "Malignant Neoplasm of Colon (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1001)
  • "Coverage: Payer" using "Payer (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.114222.4.11.3591)
  • "Observation: Fecal Occult Blood Test (FOBT)" using "Fecal Occult Blood Test (FOBT) (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1011)
  • "Observation: FIT DNA" using "FIT DNA (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1039)
  • "Procedure: Colonoscopy" using "Colonoscopy (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1020)
  • "Procedure: CT Colonography" using "CT Colonography (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.108.12.1038)
  • "Procedure: Flexible Sigmoidoscopy" using "Flexible Sigmoidoscopy (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1010)
  • "Procedure: Total Colectomy" using "Total Colectomy (http://cts.nlm.nih.gov/fhir/ValueSet/2.16.840.1.113883.3.464.1003.198.12.1019)

Supplemental Data Elements

      •   SDE."SDE Ethnicity"
       
      •   SDE."SDE Payer"
       
      •   SDE."SDE Race"
       
      •   SDE."SDE Sex"
       

Risk Adjustment Variables

  • None