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ABIM Cancer Screening PIM™Practice Improvement Module    Measures Catalogue
Cancer Screening Measures Catalogue                                                                               Septembe...
Introduction:This catalogue provides information related to the American Board of Internal Medicine’s Cancer Screening Pra...
1.   Patients are age 40 and older;    2.   Management decisions regarding their cancer screenings are made primarily by p...
Cancer Screening - PROCESSES OF CAREDocumentation of Family HistoryMeasure Title              Description                 ...
CANCER SCREENING - PROCESSES OF CAREPhysical ExaminationMeasure Title               Description                        Num...
Appropriate Documentation of Habits, Exposures, and RisksMeasure Title              Description                         Nu...
Appropriate Counseling and ReferralsMeasure Title             Description                            Numerator            ...
Screenings, Tests & EvaluationsMeasure Title              Description                         Numerator                   ...
Screenings, Tests & EvaluationsMeasure Title             Description                         Numerator                    ...
Screenings, Tests & EvaluationsMeasure Title              Description                          Numerator                  ...
Potential OveruseMeasure Title              Description                        Numerator                          Denomina...
Potential OveruseMeasure Title              Description                         Numerator                            Denom...
PATIENT EXPERIENCE: CANCER SCREENING – PROCESSES OF CAREAppropriate Documentation of Habits, Exposures, and RisksMeasure T...
Appropriate Counseling and ReferralsMeasure Title            Description                       Numerator                  ...
Patient-Centered CareMeasure Title              Description                           Numerator                           ...
Access to the PracticeMeasure Title            Description                       Numerator                           Denom...
Access to the PracticeMeasure Title            Description                         Numerator                           Den...
Access to the PracticeMeasure Title                  Description                                Numerator                 ...
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ABIM Cancer Screening PIM™ Practice Improvement Module Measures Catalogue - American Board of Internal Medicine

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Measures (3) This PIM examines the care you provide to your patients by addressing key processes and outcomes of preventive care based on recommendations of the U.S. Preventive Services Task Force, the National Cancer Institute, the American Cancer Society, and the American College of Radiology.

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Transcript of "ABIM Cancer Screening PIM™ Practice Improvement Module Measures Catalogue - American Board of Internal Medicine"

  1. 1. ABIM Cancer Screening PIM™Practice Improvement Module Measures Catalogue
  2. 2. Cancer Screening Measures Catalogue September 2010 TABLE OF CONTENTS Introduction ............................................................................................................................................ 3 Processes of Care Physical Examination........................................................................................................................................... 6 Appropriate Documentation of Habits, Exposures, and Risks ...........................................................................................6 Appropriate Counseling and Referrals .................................................................................................................................8 Screenings, Tests & Evaluations...........................................................................................................................................9 Patient-Centered Care ..........................................................................................................................................................11 Potential Overuse .................................................................................................................................................................12 Patient Experience: Processes of Care Appropriate Documentation of Habits, Exposures, and Risks ................................................................................ 14 Appropriate Counseling and Referrals ...............................................................................................................................14 Patient-Centered Care ..........................................................................................................................................................15 Patient Satisfaction...............................................................................................................................................................16 Access to the Practice..........................................................................................................................................................17Cancer Screening Measure Catalog September 2010 Page 2 of 19
  3. 3. Introduction:This catalogue provides information related to the American Board of Internal Medicine’s Cancer Screening PracticeImprovement Module®. It is written in language that addresses the physician who might choose to complete this module, and itdetails the specifics of the module. Included is information regarding: • Purpose and structuring of the module • Patient inclusion criteria • Detailed description of the measuresThis PIM examines the care you provide to your patients by addressing key processes and outcomes of preventive care based onrecommendations of the U.S. Preventive Services Task Force, the National Cancer Institute, the American Cancer Society, and theAmerican College of Radiology.The PIM is divided into three parts, with multiple sections in each part.Part 1 -Performance DataProvide baseline data about your practices current performance by... • Surveying your patients • Reviewing your charts • Assessing your practice systemsThe 17 patient survey measures and 31 chart review measures are summarized below. ABIM requires a minimum of 25 patientsurveys and a minimum of 25 chart reviews.The practice systems assessment is comprised of multiple pages of questions covering various aspects of practice structure andprotocols.Patients can be included in this module if all of the following are true:Cancer Screening Measure Catalog September 2010 Page 3 of 19
  4. 4. 1. Patients are age 40 and older; 2. Management decisions regarding their cancer screenings are made primarily by providers in the practice; 3. They have been patients in the practice for at least one year; AND 4. They have been seen by the practice within the past 12 months.Patients should be excluded from this module if the following is true: 1. They are unable to complete the patient survey, even with assistance. OR 2. They have a terminal illness, or cancer screening is not indicated because of limited life expectancy.Part 2 - Quality Improvement (QI) PlanDevelop a plan for improving one aspect of your practice after reviewing the analysis of your current performance data. The analysiswill include many aspects of care you provide to your patients. Ultimately, you will target only one of these to use in this qualityimprovement (QI) cycle.Part 3 - RemeasurementRemeasure your performance data after you have implemented your QI plan to see if you achieved your goal. Then, you will reflect onthe process of developing and implementing a QI plan.You may claim CME credit for completing this activity. The University of Pennsylvania School of Medicine designates thiseducational activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM.Cancer Screening Measure Catalog September 2010 Page 4 of 19
  5. 5. Cancer Screening - PROCESSES OF CAREDocumentation of Family HistoryMeasure Title Description Numerator Denominator RationaleMedical record Female patients in the sample Number of female patients in the Number of female The risk conferred by a familydocuments whether or whose medical record sample whose medical record patients in the history of breast cancer has beennot patient has a family documented whether or not documented whether or not sample. assessed in both case-control andhistory of breast cancer patient has a family history of patient has a family history of cohort studies, using volunteer and breast cancer. breast cancer. population-based samples, with generally consistent results. In a pooled analysis of 38 studies, the relative risk (RR) of breast cancer conferred by a first-degree relative with breast cancer was 2.1. Risk increases with the number of affected relatives, and when the affected relatives are of younger age at diagnosis.Medical record Female patients in the sample Number of female patients in the Number of female The single greatest ovarian cancerdocuments whether or whose medical record sample whose medical record patients in the risk factor is a family history of thenot patient has a family documented whether or not documented whether or not sample. disease. A large meta-analysis ofhistory of ovarian patient has a family history of patient has a family history of 15 published studies estimated ancancer ovarian cancer. ovarian cancer. odds ratio (OR) of 3.1 for the risk of ovarian cancer associated with at least one first-degree relative with ovarian cancer.Medical record Male patients in the sample Number of male patients in the Number of male Men with a family history ofdocuments whether or whose medical record sample whose medical record patients in the prostate cancer are at increasednot patient has a family documented whether or not documented whether or not sample. risk for diagnosis of and death fromhistory of prostate patient has a family history of patient has a family history of prostate cancercancer prostate cancer. prostate cancer.Medical record Patients in the sample whose Number of patients in the sample Number of patients Numerous studies that havedocuments whether or medical record documented whose medical record in the sample. consistently found that there is anot patient has a family whether or not patient has a documented whether or not twofold to threefold increased risk ofhistory of colon cancer family history of colon cancer or patient has a family history of colorectal cancer in people withor adenomatous polyps adenomatous polyps. colon cancer or adenomatous first-degree relatives affected with polyps. the disease. Persons with a family history of adenomatous polyps may also have an increased risk of colorectal cancer.Cancer Screening Measure Catalog September 2010 Page 5 of 19
  6. 6. CANCER SCREENING - PROCESSES OF CAREPhysical ExaminationMeasure Title Description Numerator Denominator RationaleHeight Patients in the sample with Number of patients in the sample Number of patients height documented who have height documented in the sample.Weight Patients in the sample with Number of patients in the sample Number of patients weight documented. who have weight documented. in the sample.Appropriate Documentation of Habits, Exposures, and RisksMeasure Title Description Numerator Denominator RationaleMedical record Patients in the sample whose Number of patients in the sample Number of patients The routine and thoroughdocuments information current smoking status was whose current smoking status in the sample. assessment of tobacco use isabout patients’ smoking documented. was documented. important as a means of preventingstatus smoking or encouraging cessation.Medical record Patients in the sample who are Number of patients in the sample Number of patients The routine and thoroughdocuments information current non-smokers whose who are current non-smokers in the sample who assessment of tobacco use isabout patients’ former former smoking status was whose former smoking status are current non- important as a means of preventingsmoking status documented. was documented. smokers. smoking or encouraging cessation.Medical record Patients in the sample who are Number of patients in the sample Number of patients Secondhand smoke is classified asdocuments information current non-smokers whose who are current non-smokers in the sample who a "known human carcinogen"about patients’ exposure to second-hand smoke whose exposure to second-hand are current non- (cancer-causing agent) by the U.S.exposure to second- was documented. smoke was documented. smokers. Environmental Protection Agencyhand smoke (EPA), the U.S. National Toxicology Program, and the International Agency for Research on Cancer (IARC).Medical record Patients in the sample whose Number of patients in the sample Number of patients Good evidence has been found thatdocuments information status regarding alcohol use whose status regarding alcohol in the sample. screening regarding alcohol use canabout patients’ status (current, former, or non-user) use (current, former, or non- accurately identify patients whoseregarding alcohol use was documented. user) was documented. levels or patterns of alcohol(current, former, or non- consumption place them at risk foruser) increased morbidity and mortality.Medical record Patients in the sample whose Number of patients in the sample Number of patients Higher levels of alcoholdocuments information current level of alcohol use was whose current level of alcohol in the sample, consumption have been linked toCancer Screening Measure Catalog September 2010 Page 6 of 19
  7. 7. Appropriate Documentation of Habits, Exposures, and RisksMeasure Title Description Numerator Denominator Rationaleabout patients’ current documented. use was documented. excluding patients increased risk for cancers of thelevel of alcohol use who do not currently head and neck, digestive tract, liver, drink or have never and breast, as well as cirrhosis, consumed alcohol. diseases of the central nervous system, and hypertension.Medical record Patients in the sample whose Number of patients in the sample Number of patients Epidemiologic research has showndocuments information prior history of level of alcohol whose prior history of level of in the sample, a dose-dependent associationabout patients’ prior use was documented. alcohol use was documented. excluding patients between alcohol consumption andhistory of alcohol use who have never certain types of cancer, as well as consumed alcohol. other health problems.Medical record Patients in the sample whose Number of patients in the sample Number of patients A sexual history is important for alldocuments information sexual history was documented. whose sexual history was in the sample. patients to provide information thatabout patients’ sexual documented. identifies those at risk for sexuallyhistory transmitted diseases, including HIV, and to guide risk-reduction counseling.Medical record Patients in the sample whose Number of patients in the sample Number of patients A sexual history is important for alldocuments information risk for acquiring a sexually whose risk for acquiring a in the sample. patients to provide information thatabout patients’ risk for transmitted infection was sexually transmitted infection identifies those at risk for sexuallyacquiring a sexually documented. was documented transmitted diseases, including HIV,transmitted infection and to guide risk-reduction counseling.Medical record Patients in the sample whose Number of patients in the sample Number of patients Many epidemiologic studies indicatedocuments information current or prior occupational whose current or prior in the sample. an association betweenabout patients’ current exposures that could affect occupational exposures that occupational exposures and specificor prior occupational health were documented. could affect health were types of cancer.exposures that could documented.affect healthCancer Screening Measure Catalog September 2010 Page 7 of 19
  8. 8. Appropriate Counseling and ReferralsMeasure Title Description Numerator Denominator RationaleReferral to a Obese patients in the sample Number of obese patients in the Number of patients There is fair to good evidence thatmultidisciplinary who were reported as being sample who were reported as in the sample who programs offering intensiveprogram to address referred to a multidisciplinary being referred to a are obese. When counseling and behavioralrisks of obesity program to address risks of multidisciplinary program to height and weight interventions produce modest but obesity. address risks of obesity. were both available, sustained weight loss in obese this was defined as a adults. BMI of >=30 kg/m2. When height and/or weight were not available, the physicians assessment of body habitus as "obese" was used.Discussion of risks and Patients in the sample, excluding Number of patients in the Number of patients There is good evidence thatpotential benefits of patients who have never sample, excluding patients who in the sample, screening and behavioralalcohol use consumed alcohol, who were have never consumed alcohol, excluding patients counseling for alcohol misuse reported as having a discussion who were reported as having a who have never benefits patients. of risks and potential benefits of discussion of risks and potential consumed alcohol. alcohol use. benefits of alcohol use.Referral for high- Patients in the sample at high Number of patients in the sample Number of patients There is convincing evidence thatintensity behavioral risk for STIs who were reported at high risk for STIs who were in the sample at high high-intensity behavioral counselingcounseling to reduce as having received high-intensity reported as having received risk for STIs. interventions targeted to sexuallythe risk of sexually behavioral counseling to reduce high-intensity behavioral active adolescents and adults attransmitted infections the risk of sexually transmitted counseling to reduce the risk of increased risk for STIs reduce the infections. sexually transmitted infections. incidence of STIs.Smoking cessation Patients in the sample who are Number of patients in the sample Number of patients A number of large randomizedsupport within the past smokers and who received who are smokers and who in the sample who clinical trials have demonstrated the12 months smoking cessation counseling or received smoking cessation are smokers. efficacy and cost-effectiveness of treatment during the 12 month counseling or treatment during smoking cessation counseling in period prior to the visit date, with the 12 month period prior to the changing smoking behavior and a three-month grace period. visit date, with a three-month reducing tobacco use. The routine grace period. and thorough assessment of tobacco use is an important step in smoking cessation counseling.Cancer Screening Measure Catalog September 2010 Page 8 of 19
  9. 9. Screenings, Tests & EvaluationsMeasure Title Description Numerator Denominator RationaleColorectal cancer Patients in the sample 40 to 75 Number of patients in the sample Number of patients Colorectal cancer is the third mostscreening in patients 40 years old who were reported as 40 to 75 years old with a family in the sample 50 to common type of cancer and theto 75 years old that having colorectal cancer history of colorectal cancer or 75 years old AND second leading cause of cancercomplies with screening that complies with adenomatous polyps who were patients 40 to 75 death in the United States. Theguidelines guidelines. Patients with a reported as having a years old who have evidence is convincing that personal history of colorectal colonoscopy within 60 months, a family history of screening for colorectal cancer with cancer or adenomatous polyps plus three month grace period colorectal cancer or fecal occult blood testing, are excluded from this measure. OR patients 50 to 75 without a adenomatous sigmoidoscopy, or colonoscopy personal or family history of polyps, excluding detects early-stage cancer and colorectal cancer or those patients with a adenomatous polyps and reduces adenomatous polyps who were personal history of colorectal cancer mortality. The reported as having 1) a colorectal cancer or evidence base regarding a mortality colonoscopy within 120 months, adenomatous benefit for newer screening plus three month grace period; polyps. modalities is still developing. OR 2) a high sensitivity guaiac- based FOBT within 12 months, plus three month grace period; OR 3) a flexible sigmoidoscopy within 60 months plus three month grace period AND a high sensitivity guaiac-based FOBT or a FIT within 36 months, plus three month grace period; OR 4) a CT colonography within 60 months, plus three month grace period; OR 5) a DCBE within 60 months, plus three month grace period; OR 6) a FIT within 12 months, plus three month grace period; OR 7) a high-sensitivity fecal DNA testing within 60 months, plus three month grace period.Pap smear for cervical Female patients in the sample Number of female patients in the Number of female Good evidence from multiplecancer screening within 40 to 65 years old and female sample 40 to 65 years old and patients in the observational studies has shownthree years (every year patients age 66 and older at high female patients age 66 and older sample 40 to 65 that screening with cervical cytologyfor patients with risk for STIs who were reported at high risk for STIs without years old and female (Pap smears) reduces incidence ofHIV/AIDS) as having a pap smear for HIV/AIDS who were reported as patients age 66 and and mortality from cervical cancer. cervical cancer screening 1) having a pap smear for cervical older at high risk forCancer Screening Measure Catalog September 2010 Page 9 of 19
  10. 10. Screenings, Tests & EvaluationsMeasure Title Description Numerator Denominator Rationale within 36 months, plus three cancer screening 1) within 36 STIs, excluding month grace period for those months, plus three month grace those who were not without HIV/AIDS, OR 2) within period for those without tested because they 12 months, plus three month HIV/AIDS, OR 2) within 12 have no cervix. grace period for those with months, plus three month grace HIV/AIDS. period for those with HIV/AIDS, excluding those who were not tested because they have no cervix.Mammography for Female patients in the sample Number of female patients in the Number of female Breast cancer is the second-leadingbreast cancer screening 40 to 49 years old without a sample 40 to 49 years old patients in the cause of cancer death amongwithin two years: personal history of breast cancer without a personal history of sample 40 to 49 women in the United States. Therewomen age 40 to 49 in the sample who were reported breast cancer in the sample who years old without is convincing evidence that as having a mammography for were reported as having a personal history of screening with film mammography breast cancer screening within mammography for breast cancer breast cancer. reduces breast cancer mortality, 24 months, plus three month screening within 24 months, plus with a greater absolute reduction for grace period. three month grace period. women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years. Among younger women, meta-analyses of randomized, controlled trials demonstrate a 7% to 23% reduction in breast cancer mortality rates from screening mammography in women 40 to 49 years of age.Mammography for Female patients in the sample Number of female patients in the Number of female Breast cancer is the second-leadingbreast cancer screening age 50 and over without a sample age 50 and over without patients in the cause of cancer death amongwithin two years: personal history of breast cancer a personal history of breast sample age 50 and women in the United States. Therewomen age 50 and who were reported as having a cancer who were reported as over without a is convincing evidence thatover mammography for breast cancer having a mammography for personal history of screening with film mammography screening within 24 months, plus breast cancer screening within breast cancer. reduces breast cancer mortality, three month grace period. 24 months, plus three month with a greater absolute reduction for grace period. women aged 50 to 74 years than for women aged 40 to 49 years. The strongest evidence for the greatest benefit is among women aged 60 to 69 years.Cancer Screening Measure Catalog September 2010 Page 10 of 19
  11. 11. Screenings, Tests & EvaluationsMeasure Title Description Numerator Denominator RationaleProstate cancer testing Male patients in the sample 50 to Number of male patients in the Number of male Prostate cancer is the mostdone for those desiring 74 years old OR male African sample 50 to 74 years old OR patients in the common non-skin cancer and thetesting, age 50 to 74 American patients 45 to 74 years male African American patients sample 50 to 74 second leading cause of cancer(45 to 74 for African old OR male patients 40 to 74 45 to 74 years old OR male years old OR male death in men in the United States.Americans and 40 to 74 years old with a family history of patients 40 to 74 years old with a African American Because current evidence iswith a family history of prostate cancer who were family history of prostate cancer patients 45 to 74 insufficient to determine if theprostate cancer) reported as desiring prostate who were reported as desiring years old OR male benefits of screening for prostate cancer screening and having prostate cancer screening and patients 40 to 74 cancer outweigh the risks, the screening done within 12 having screening done within 12 years old with a decision about screening should be months, plus three month grace months, plus three month grace family history of shared by an individual patient and period. period. prostate cancer who his physician. were reported as desiring to have screening for prostate cancer.HIV infection (includes Patients in the sample 40 to 64 Number of patients in the sample Number of patients Early identification and treatment forpatients who received years old who were reported as 40 to 64 years old who were in the sample 40 to HIV provides substantial healthtest and those who having been tested for HIV reported as having been tested 64 years old, benefit by extending the length ofwere offered but infection OR being offered but for HIV infection OR being excluding those who life of the person identified asdeclined testing) declined testing, excluding those offered but declined testing, were not offered HIV having HIV. who were not offered testing excluding those who were not testing because local because local prevalence is offered testing because local prevalence is <1:1,000 and those with prevalence is <1:1,000 and <1:1,000 and those HIV/AIDS. those with HIV/AIDS. with HIV/AIDS.Patient-Centered CareMeasure Title Description Numerator Denominator RationaleMedical record Applicable patients in the sample Number of applicable patients in Number of male Because current evidence isdocuments patient who were reported as having an the sample who were reported as patients in the sample insufficient to determine if thepreferences concerning assessment of preferences having an assessment of age 50 to 74 OR male benefits of screening for prostateprostate cancer regarding prostate cancer preferences regarding prostate African American cancer outweigh the risks, mostscreening screening. cancer screening. Applicable patients age 45 to 74 major U.S. medical organizations patients are male patients age 50 OR male patients age recommend that clinicians discuss to 74 OR male African American 40 to 74 with a family the potential benefits and known patients age 45 to 74 OR male history of prostate harms of PSA screening with their patients age 40 to 74 with a family cancer, excluding patients, consider their patients history of prostate cancer, those who have a preferences, and individualize excluding those who have been personal history of screening decisions. diagnosed with prostate cancer. prostate cancer.Cancer Screening Measure Catalog September 2010 Page 11 of 19
  12. 12. Potential OveruseMeasure Title Description Numerator Denominator RationaleColorectal cancer Patients in the sample 76 to 85 Number of patients in the sample Number of patients There is adequate evidence that thescreening in patients 76 years old who were reported as 76 to 85 years old who were in the sample 76 to benefits of detection of colorectalto 85 having colorectal cancer reported as having colorectal 85 years old without cancer and early intervention screening at a date when cancer screening at a date when a personal history of decline after age 75 years. The lead patients were age 76 and over, patients were age 76 and over, colorectal cancer or time between the detection and excluding those who have a excluding those who have a adenomatous treatment of colorectal neoplasia personal history of colorectal personal history of colorectal polyps. and a mortality benefit is cancer or adenomatous polyps. cancer or adenomatous polyps. substantial, and competing causes of mortality make it progressively less likely that this benefit will be realized with advancing age.Colorectal cancer Patients in the sample age 86 Number of patients in the sample Number of patients The USPSTF concludes that, forscreening in patients 86 and over who were reported as age 86 years and over who were in the sample age 86 adults older than age 85 years,and over having colorectal cancer reported as having colorectal and over without a there is moderate certainty that the screening at a date when cancer screening at a date when personal history of benefits of screening do not patients were age 86 and over, patients were age 86 and over, colorectal cancer or outweigh the harms, and these excluding those who have a excluding those who have a adenomatous patients should not undergo personal history of colorectal personal history of colorectal polyps. screening. cancer or adenomatous polyps. cancer or adenomatous polyps.Cervical cancer Female patients in the sample Number of female patients in the Number of female The USPSTF found limitedscreening in women 66 age 66 and over who were not at sample age 66 and over who patients in the evidence to determine the benefitsand over high risk for acquiring STIs and were not at high risk for sample age 66 and of continued screening in women not having HIV/AIDS and who acquiring STIs and not having older, EXCEPT older than 65. The yield of were reported as having cervical HIV/AIDS and who were those at high risk for screening is low in previously cancer screening at a date when reported as having cervical STI, having screened women older than 65 due patients were age 66 and over. cancer screening at a date when HIV/AIDS, and to the declining incidence of high- Patients who have no cervix are patients were age 66 and over. having no cervix. grade cervical lesions after middle excluded. Patients who have no cervix are age. There is fair evidence that excluded. screening women older than 65 is associated with an increased risk for potential harms, including false- positive results and invasive procedures. The USPSTF concludes that the potential harms of screening are likely to exceed benefits among older women who have had normal results previously and who are not otherwise at high risk for cervical cancer.Cancer Screening Measure Catalog September 2010 Page 12 of 19
  13. 13. Potential OveruseMeasure Title Description Numerator Denominator RationaleProstate cancer Male patients in the sample 50 to Number of male patients in the Number of male Because current evidence isscreening in men 50 to 74 years old OR male African sample 50 to 74 years old OR patients in the insufficient to determine if the74 (45 to 74 for African American patients 45 to 74 years male African American patients sample 50 to 74 benefits of screening for prostateAmericans and 40 to 74 old OR male patients years old 45 to 74 years old OR male years old OR male cancer outweigh the risks, mostwith a family history of 40 to 74 with a family history of patients 40 to 74 years old with a African American major U.S. medical organizationsprostate cancer) who prostate cancer who were family history of prostate cancer patients 45 to 74 recommend that clinicians discussdid not desire screening reported as not desiring prostate who were reported as not years old OR male the potential benefits and knownor in whom preference cancer screening OR in whom desiring prostate cancer patients 40 to 74 harms of PSA screening with theirwas not assessed preference were not assessed, screening OR in whom years old with a patients, consider their patients but had prostate cancer preference were not assessed, family history of preferences, and individualize screening. but had prostate cancer prostate cancer who screening decisions. It follows that screening. did not desire testing patients who do not desire prostate OR in whom cancer screening should not have it preference were not done, and that physicians should assessed. not act unilaterally prior to assessing patient preferences.Prostate cancer Male patients in the sample age Number of male patients in the Number of male In men age 75 years or older, thescreening in men 75 75 and over without a personal sample age 75 and over without patients in the USPSTF found adequate evidenceand over history of prostate cancer who a personal history of prostate sample age 75 and that the incremental benefits of had prostate cancer screening at cancer who had prostate cancer older without a treatment for prostate cancer a date when patients were age screening at a date when personal history of detected by screening are small to 75 and over. patients were age 75 and over. prostate cancer. none, and that these patients should not undergo screening.Cancer Screening Measure Catalog September 2010 Page 13 of 19
  14. 14. PATIENT EXPERIENCE: CANCER SCREENING – PROCESSES OF CAREAppropriate Documentation of Habits, Exposures, and RisksMeasure Title Description Numerator Denominator RationalePatient recalls being Patients in the sample who Number of patients in the sample Number of patients Good evidence has been found thatasked about patients’ reported being asked if patient who reported being asked if in the sample. To be screening regarding alcohol use canstatus regarding alcohol drinks alcohol. patient drinks alcohol. included in the accurately identify patients whoseuse. sample, patients levels or patterns of alcohol need to be 40 and consumption place them at risk for older. increased morbidity and mortality.Patient recalls being Patients in the sample who Number of patients in the sample Number of patients A sexual history is important for allasked for information reported being asked for who reported being asked for in the sample. To be patients to provide information thatabout patients’ sexual information about patients’ information about patients’ included in the identifies those at risk for sexuallyhistory sexual history in the past 12 sexual history in the past 12 sample, patients transmitted diseases, including HIV, months. months. need to be 40 and and to guide risk-reduction older. counseling.Patient recalls being Patients in the sample who Number of patients in the sample Number of patients Many epidemiologic studies indicateasked for information reported being asked for who reported being asked for in the sample. To be an association betweenabout patients’ work information about patients’ work information about patients’ work included in the occupational exposures and specifichistory history. history. sample, patients types of cancer. need to be 40 and older.Appropriate Counseling and ReferralsMeasure Title Description Numerator Denominator RationalePatient reports being Patients in the sample who are Number of patients in the sample Number of patients There is convincing evidence thatadvised to stop current smokers who reported who are current smokers who in the sample who smoking cessation interventions,smoking that their doctor had advised reported that their doctor had reported that they beginning with advising patients to them more than once to stop advised them more than once to currently smoke stop smoking, are effective in smoking cigarettes. stop smoking cigarettes cigarettes. To be increasing the likelihood that included in the smokers successfully quit. sample, patients need to be 40 and older.Patient reports being Patients in the sample who are Number of patients in the sample Number of patients There is convincing evidence thatoffered smoking current smokers who reported who are current smokers who in the sample who smoking cessation interventions,cessation that their doctor had offered reported that their doctor had reported that they are effective in increasing theassistance/counseling smoking cessation assistance or offered smoking cessation currently smoke likelihood that smokers successfullyCancer Screening Measure Catalog September 2010 Page 14 of 19
  15. 15. Appropriate Counseling and ReferralsMeasure Title Description Numerator Denominator Rationale counseling. assistance or counseling. cigarettes. To be quit. The key elements of effective included in the smoking cessation counseling sample, patients include identifying tobacco users, need to be 40 and offering consistent and repeated older. cessation advice that is of personal medical relevance, adjuncts such as nicotine replacement therapy (NRT), follow-up contact, and advice regarding intensive cessation therapy.Patient-Centered CareMeasure Title Description Numerator Denominator RationalePatient reports being Male patients in the sample age Number of male patients in the Number of male Because current evidence isshared decision-making 50 and older who reported that sample age 50 and older who patients in the insufficient to determine if theabout prostate cancer they were shared decision- reported that they were shared sample who were benefits of screening for prostatescreening making about prostate cancer decision-making about prostate age 50 and older, cancer outweigh the risks, most screening, excluding those who cancer screening, excluding excluding those who major U.S. medical organizations have a personal history of those who have a personal have a personal recommend that clinicians discuss prostate cancer. history of prostate cancer. history of prostate the potential benefits and known cancer. harms of PSA screening with their patients, consider their patients preferences, and individualize screening decisions. Patient reports being Female patients in the sample Number of female patients in Number of female shared decision- age 40 to 49 who reported that the sample age 40 to 49 who patients in the making about they were shared decision- reported that they were shared sample age 40 to mammography making about mammography, decision-making about 49, excluding those excluding those who have a mammography, excluding who have a personal history of breast those who have a personal personal history of cancer. history of breast cancer. breast cancer. Patient reports being Female patients in the sample Number of female patients in Number of female recommended age 50 and older who reported the sample age 50 and older patients in the mammogram to that they were recommended who reported that they were sample age 50 and screen for breast mammogram to screen for recommended mammogram to older, excluding cancer breast cancer, excluding those screen for breast cancer, those who have a who have a personal history of excluding those who have a personal history ofCancer Screening Measure Catalog September 2010 Page 15 of 19
  16. 16. Patient-Centered CareMeasure Title Description Numerator Denominator Rationale breast cancer. personal history of breast breast cancer. cancer. Patient reports being Female patients in the sample Number of female patients in Number of female recommended pap age 65 and younger who were the sample age 65 and younger patients in the smear to screen for recommended pap smear to who were recommended pap sample age 65 and cervical cancer screen for cervical cancer, smear to screen for cervical younger, excluding excluding those who have a cancer, excluding those who those who have a personal history of cervical have a personal history of personal history of cancer. cervical cancer. cervical cancer. Patient reports being Patients in the sample age 50 Number of patients in the Number of patients recommended and older who were sample age 50 and older who in the sample who screening test for recommended screening test were recommended screening were age 50 and colorectal cancer for colorectal cancer, excluding test for colorectal cancer, older, excluding those who have a personal excluding those who have a those who have a history of colorectal cancer. personal history of colorectal personal history of cancer. colorectal cancer.Patient SatisfactionMeasure Title Description Numerator Denominator RationalePractice is excellent at Patients in the sample who Number of patients in the sample Number of patients Care should be patient-centered,encouraging questions reported that practice is excellent who responded "excellent" to the in the sample. To be respectful of and responsive toand answering them at encouraging questions and question "How is this practice at included in the individual patient preferences,clearly answering them clearly encouraging you to ask sample, patients needs, and values. Patients overall questions and answering them need to be 40 and experiences with doctors are clearly?" older. shaped by communication style and content. Both contribute to the likelihood that a patient will understand and be able to follow treatment recommendations.Patient would Patients in the sample who Number of patients in the sample Number of patients Consumer satisfaction withrecommend practice to reported that they would who responded "Yes" to the in the sample. To be healthcare is recognized as aothers recommend the practice to survey question, "Would you included in the measure of quality. family or friends. recommend this practice to sample, patients family or friends?" need to be 40 and older.Cancer Screening Measure Catalog September 2010 Page 16 of 19
  17. 17. Access to the PracticeMeasure Title Description Numerator Denominator RationalePatient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicineproblem with report no problems scheduling who responded "Not a problem" in the sample, recommends that patients shouldscheduling appointments with the practice. to the survey question, "In the excluding those who receive care whenever they need itappointments past 12 months, how much of a responded "Not and in many forms, not just face-to- problem has it been to schedule applicable" to the face visits. This implies that the appointments with this practice?" survey question, "In health care system should be To be included in the sample, the past 12 months, responsive at all times (24 hours a patients need to be between the how much of a day, every day) and that access to ages of 40 and 110. problem has it been care should be provided over the to schedule Internet, by telephone, and by other appointments with means in addition to face-to-face this practice?" To visits. be included in the sample, patients need to be between the ages of 40 and 110.Patient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicineproblem with reaching report no problems reaching the who responded "Not a problem" in the sample, recommends that patients shouldsomeone with a practice with questions or to the survey question, "In the excluding those who receive care whenever they need itquestion concerns. past 12 months, how much of a responded "Not and in many forms, not just face-to- problem has it been to reach this applicable" to the face visits. This implies that the practice when you have a survey question, "In health care system should be question or concern?" To be the past 12 months, responsive at all times (24 hours a included in the sample, patients how much of a day, every day) and that access to need to be between the ages of problem has it been care should be provided over the 40 and 110. to reach this practice Internet, by telephone, and by other when you have a means in addition to face-to-face question or visits. concern?" To be included in the sample, patients need to between the ages of 40 and 110.Patient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicineproblem with obtaining report no problems obtaining who responded "Not a problem" in the sample, recommends that patients shouldprescription refills prescription refills from the to the survey question, "In the excluding those who receive care whenever they need it practice. past 12 months, how much of a responded "Not and in many forms, not just face-to-Cancer Screening Measure Catalog September 2010 Page 17 of 19
  18. 18. Access to the PracticeMeasure Title Description Numerator Denominator Rationale problem has it been to get a applicable" to the face visits. This implies that the prescription refill from this survey question, "In health care system should be practice?" To be included in the the past 12 months, responsive at all times (24 hours a sample, patients need to be how much of a day, every day) and that access to between the ages of 40 and 110. problem has it been care should be provided over the to get a prescription Internet, by telephone, and by other refill from this means in addition to face-to-face practice?" To be visits. included in the sample, patients need to be between the ages of 40 and 110.Patient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicineproblem with obtaining report no problems obtaining test who responded "Not a problem" in the sample, recommends that patients shouldtest results results from the practice. to the survey question, "In the excluding those who receive care whenever they need it past 12 months, how much of a responded "Not and in many forms, not just face-to- problem has it been to get your applicable" to the face visits. This implies that the laboratory test results from this survey question, "In health care system should be practice?" To be included in the the past 12 months, responsive at all times (24 hours a sample, patients need to be how much of a day, every day) and that access to between the ages of 40 and 110. problem has it been care should be provided over the to get your Internet, by telephone, and by other laboratory test means in addition to face-to-face results from this visits. practice?" To be included in the sample, patients need to be between the ages of 40 and 110.Patient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicineproblem with obtaining report no problems obtaining who responded "Not a problem" in the sample, recommends that patients shouldreferrals referrals from the practice. to the survey question, "In the excluding those who receive care whenever they need it past 12 months, how much of a responded "Not and in many forms, not just face-to- problem has it been to get a applicable" to the face visits. This implies that the referral from this practice?" To survey question, "In health care system should be be included in the sample, the past 12 months, responsive at all times (24 hours a patients need to be between the how much of a day, every day) and that access toCancer Screening Measure Catalog September 2010 Page 18 of 19
  19. 19. Access to the PracticeMeasure Title Description Numerator Denominator Rationale ages of 40 and 110. problem has it been care should be provided over the to get a referral from Internet, by telephone, and by other this practice?" To means in addition to face-to-face be included in the visits. sample, patients need to be between the ages of 40 and 110.© 2010 American Board of Internal Medicine. All rights reserved. ABIM publications are protected by United States and international copyright laws. Written permission for any reproduction oradaptation, in whole or in part, in any format or medium must be obtained from ABIM. Contact request@abim.org.Cancer Screening Measure Catalog September 2010 Page 19 of 19
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