Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients (NQF 0389)

eMeasure Name Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients eMeasure Id 77D11C01-F4C2-4006-AFED-4EBFFAF27D55
Version number 1 eMeasure Set Id B2E593F4-44F7-4E78-B565-DB6128A15617
Available Date No information Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association - Physician Consortium for Performance Improvement
Endorsed by National Quality Forum
Description Percentage of patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy who did not have a bone scan performed at any time since diagnosis of prostate cancer
Copyright
© 2010 American Medical Association. All Rights Reserved
Measure scoring Proportion
Measure type Process
Stratification
None
Risk Adjustment
None
Data Aggregation
Rationale
A bone scan is generally not required for staging prostate cancer in men with a low risk of recurrence and receiving primary therapy. This measure is written as a negative measure so that the performance goal is 100%, consistent with the other measures for this condition.
Clinical Recommendation Statement
Routine use of a bone scan is not required for staging asymptomatic men with clinically localized prostate cancer when their PSA is equal to or less than 20.0 ng/mL (AUA).
Patients with a life expectancy of greater than 5 years or symptomatic:
• A bone scan is appropriate for T1 to T2 disease in the presence of a PSA greater than 20 ng/mL, Gleason score of 8 or higher, clinical stage of T3 to T4, or symptomatic disease.  
• Patients at higher risk of metastatic disease may undergo pelvic computed tomography (CT) or magnetic resonance imaging (MRI) scanning with possible fine-needle aspiration of enlarged lymph nodes or staging lymph node dissection. Nomograms or risk tables may be used to identify patients with a higher likelihood of having metastatic disease. If the nomogram indicates a probability of lymph node involvement greater than 20% or if the patient is stage T3 or T4, this is recommended as a threshold for doing a staging CT scan or MRI evaluation.
For all other patients, no additional imaging is required for staging (NCCN) (Category 2A).
Improvement notation
Higher score indicates better quality
Measurement duration
12 month(s)
Reference
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Prostate Cancer. Version 2.2005. Available at: www.nccn.org/professionals/physician_gls/default.asp.
Reference
American Urological Association (AUA). Guidelines for the management of clinically localized prostate cancer: 2006 update. 2006. American Urological Association Education and Research, Inc. DRAFT copy.
Definition
Initial Patient Population(s): Patient Age:  All patients regardless of age.
Diagnosis Active:  Patient has a documented diagnosis of prostate cancer.
Definition
Denominator(s): All patients, regardless of age, with a diagnosis of prostate cancer at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy.
Definition
Denominator Exclusion(s): N/A
Definition
Numerator(s): Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer.
Definition
Denominator Exception(s): Documentation of medical reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons)
Documentation of system reason(s) for performing a bone scan (including bone scan ordered by someone other than reporting physician).
Guidance
Supplemental Data Elements
Report "Patient Characteristic: Gender" using "Gender HL7 Value Set (2.16.840.1.113883.1.11.1)"; Report "Patient Characteristic: Race" using "Race CDC Value Set (2.16.840.1.114222.4.11.836)"; Report "Patient Characteristic: Ethnicity" using "Ethnicity CDC Value Set (2.16.840.1.114222.4.11.837)"; Report "Patient Characteristic: Payer" using "Payer Source of Payment Typology Value Set (2.16.840.1.113883.3.221.5)".

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Supplemental Data Elements




Measure set CLINICAL QUALITY MEASURE SET 2011-2012