eCQM Title | Oncology: Medical and Radiation - Pain Intensity Quantified |
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eCQM Identifier (Measure Authoring Tool) | 157 | eCQM Version Number | 9.2.000 |
NQF Number | 0384e | GUID | 9a0330d0-3d9b-11e1-8634-00237d5bf174 |
Measurement Period | January 1, 20XX through December 31, 20XX | ||
Measure Steward | PCPI(R) Foundation (PCPI[R]) | ||
Measure Developer | American Medical Association (AMA) | ||
Measure Developer | PCPI(R) Foundation (PCPI[R]) | ||
Endorsed By | National Quality Forum | ||
Description |
Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified |
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Copyright |
Copyright 2020 PCPI(R) Foundation. All Rights Reserved. |
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Disclaimer |
The Measure is not a clinical guideline, does not establish a standard of medical care, and has not been tested for all potential applications. The Measure, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, 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. Commercial uses of the Measure require a license agreement between the user and the PCPI(R) Foundation (PCPI[R]). Neither the PCPI, nor the American Medical Association (AMA), nor the former AMA-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI), nor their members shall be responsible for any use of the Measure. The PCPI encourages use of the Measure by other health care professionals, where appropriate. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members and former members of the AMA-PCPI disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. CPT(R) contained in the Measure specifications is copyright 2004-2019 American Medical Association. LOINC(R) is copyright 2004-2019 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2019 International Health Terminology Standards Development Organisation. ICD-10 is copyright 2019 World Health Organization. All Rights Reserved. Due to technical limitations, registered trademarks are indicated by (R) or [R]. |
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Measure Scoring | Proportion | ||
Measure Type | Process | ||
Stratification |
None |
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Risk Adjustment |
None |
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Rate Aggregation |
This measure is intended to have one reporting rate, which aggregates the following populations into a single performance rate for reporting purposes: - Population 1: Visits for patients with a diagnosis of cancer who are currently receiving chemotherapy - Population 2: Visits for patients with a diagnosis of cancer who are currently receiving radiation therapy For the purposes of this measure, a single performance rate can be calculated as follows: Performance Rate = (Numerator 1 + Numerator 2)/ (Denominator 1 + Denominator 2) |
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Rationale |
An estimated 1.7 million new cases of cancer are diagnosed in the US each year (NIH, 2017). Pain is a commonly occurring symptom for cancer patients as 30% to 50% (510,000 to 850,000 each year based on current statistics) will experience moderate to severe pain (Wiffen, Wee, Derry, Bell, & Moore, 2017). Initial and ongoing pain assessments are essential to determine the pathophysiology of pain and ensure proper pain management. According to the National Comprehensive Cancer Network (NCCN), there is increasing evidence in oncology that survival is linked to symptom reporting and control and that pain management contributes to broad quality-of-life improvement (2018). Cancer patients have reported that pain interferes with their mood, work, relationships with other people, sleep and overall enjoyment of life (Moryl et al., 2018). To maximize patient outcomes, pain management is an essential part of oncologic management (NCCN, 2018). A recent analysis of registry data for chronic pain cancer patients found average pain intensity reported as mild (24.6% of patients), moderate (41.5%), and severe (33.9%). The study also indicated that patient report of pain relief is inversely related to the average pain intensity reported (Moryl et al., 2018). These data suggest that assessing and managing a cancer patient’s pain is critical and there remains significant room for improvement in assessing and mitigating cancer-related pain. A prospective study of changes in pain severity of cancer patients found that, at initial assessment, 47% of patients reported pain. At follow-up, the patients with pain at initial assessment reported reduced pain (32.2%), stable pain (48.2%) and worse pain (19.6%). Of the 53% of patients reporting no pain at initial assessment, 82.6% reported stable pain and 17.4% reported worse pain at follow-up assessment (Zhao et al., 2014). This study highlights the importance of initial and ongoing assessments of pain to identify gaps and ensure proper pain management. |
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Clinical Recommendation Statement |
-Screen all patients for pain at each contact. -Routinely quantify and document pain intensity and quality as characterized by the patient (whenever possible). Include patient reporting of breakthrough pain, treatments used and their impact on pain, adequacy of comfort, satisfaction with pain relief, provider assessment of impact on function, and any special issues for the patient relevant to pain treatment. If necessary, get additional information from caregiver regarding pain and impact on function. -Perform comprehensive pain assessment if new or worsening pain is present, and regularly for persisting pain. Various methods and tools exist to assess pain severity. Intensity of pain should be quantified using a numerical rating scale (i.e., 0-10), visual analog scale, categorical scale, or pictorial scale (e.g., The Faces Pain Rating Scale) (Category 2A) (National Comprehensive Cancer Network, 2019). |
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Improvement Notation |
Higher score indicates better quality |
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Reference |
Moryl, N., Dave, V., Glare, P., Bokhari, A., Malhotra, V. T., Gulati, A., … Inturrisi, C. E. (2018). Patient-Reported Outcomes and Opioid Use by Outpatient Cancer Patients. The Journal of Pain: official journal of the American Pain Society, 19(3), 278–290. doi:10.1016/j.jpain.2017.11.001 |
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Reference |
National Comprehensive Cancer Network (NCCN). (2018). NCCN Clinical Practice Guidelines in Oncology. Adult Cancer Pain Version I.2018. Retrieved from http://www.nccn.org |
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Reference |
National Comprehensive Cancer Network (NCCN). (2019). NCCN Clinical Practice Guidelines in Oncology. Adult Cancer Pain Version 3.2019. Retrieved from http://www.nccn.org |
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Reference |
National Institutes of Health - National Cancer Institute. (2017). Cancer Statistics. Retrieved from https://www.cancer.gov/about-cancer/understanding/statistics |
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Reference |
Wiffen, P. J., Wee, B., Derry, S., Bell, R. F., & Moore, R. A. (2017). Opioids for cancer pain - an overview of Cochrane reviews. The Cochrane database of systematic reviews, 7(7), CD012592. doi:10.1002/14651858.CD012592.pub2 |
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Reference |
Zhao, F., Chang, V. T., Cleeland, C., Cleary, J. F., Mitchell, E. P., Wagner, L. I., & Fisch, M. J. (2014). Determinants of pain severity changes in ambulatory patients with cancer: an analysis from Eastern Cooperative Oncology Group trial E2Z02. Journal of clinical oncology : official journal of the American Society of Clinical Oncology, 32(4), 312–319. doi:10.1200/JCO.2013.50.6071 |
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Definition |
None |
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Guidance |
This eCQM is an episode-of-care measure; the level of analysis for this measure is every visit for patients with a diagnosis of cancer who are also currently receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter where the patient and physician have a face-to-face interaction. Due to the nature of some applicable coding related to radiation therapy (e.g., delivered in multiple fractions), the billing date for certain codes may or may not be the same as the face-to-face encounter date. In this instance, for the reporting purposes of this measure, the billing date should be used to pull the appropriate patients into the initial population. It is expected, though, that the numerator criteria would be performed at the time of the actual face-to-face encounter during the series of treatments. A lookback (retrospective) period of 7 days, including the billing date, may be used to identify the actual face-to-face encounter, which is required to assess the numerator. Therefore, pain intensity should be quantified during the face-to-face encounter occurring on the actual billing date or within the 6 days prior to the billing date. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face encounter with the physician while the patient is currently receiving chemotherapy. For purposes of identifying eligible encounters, patients "currently receiving chemotherapy" refers to patients administered chemotherapy within 30 days prior to the encounter AND administered chemotherapy within 30 days after the date of the encounter. Pain intensity should be quantified using a standard instrument, such as a 0-10 numerical rating scale, visual analog scale, a categorical scale, or pictorial scale. Examples include the Faces Pain Rating Scale and the Brief Pain Inventory (BPI). This version of the eCQM uses QDM version 5.5. Please refer to the eCQI resource center (https://ecqi.healthit.gov/qdm) for more information on the QDM. |
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Transmission Format |
TBD |
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Initial Population |
All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy |
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Denominator |
Equals Initial Population |
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Denominator Exclusions |
None |
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Numerator |
Patient visits in which pain intensity is quantified |
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Numerator Exclusions |
Not Applicable |
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Denominator Exceptions |
None |
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Supplemental Data Elements |
For every patient evaluated by this measure also identify payer, race, ethnicity and sex |
"Face to Face Encounter with Ongoing Chemotherapy"
"Initial Population 1"
None
"Face to Face Encounter with Ongoing Chemotherapy" FaceToFaceEncounterWithChemo with ["Assessment, Performed": "Standardized Pain Assessment Tool"] PainAssessed such that PainAssessed.relevantDatetime during FaceToFaceEncounterWithChemo.relevantPeriod and PainAssessed.result is not null
None
None
None
"Radiation Treatment Management During Measurement Period with Cancer Diagnosis"
"Initial Population 2"
None
"Radiation Treatment Management During Measurement Period with Cancer Diagnosis" RadiationTherapy with ["Assessment, Performed": "Standardized Pain Assessment Tool"] PainAssessed such that PainAssessed.relevantDatetime during RadiationTherapy.relevantPeriod and PainAssessed.result is not null
None
None
None
["Procedure, Performed": "Chemotherapy Administration"] ChemoAdministration where ChemoAdministration.relevantPeriod during Interval[start of "Measurement Period" - 31 days, end of "Measurement Period" + 31 days )
"Initial Population 1"
"Initial Population 2"
from ["Encounter, Performed": "Office Visit"] FaceToFaceEncounter, "Chemotherapy Within 31 Days Prior and After Measurement Period" ChemoBeforeEncounter, "Chemotherapy Within 31 Days Prior and After Measurement Period" ChemoAfterEncounter, ["Diagnosis": "Cancer"] Cancer where ChemoBeforeEncounter.relevantPeriod starts 30 days or less on or before day of end of FaceToFaceEncounter.relevantPeriod and ChemoAfterEncounter.relevantPeriod starts 30 days or less on or after day of end of FaceToFaceEncounter.relevantPeriod and ChemoBeforeEncounter !~ ChemoAfterEncounter and Cancer.prevalencePeriod overlaps FaceToFaceEncounter.relevantPeriod and FaceToFaceEncounter.relevantPeriod during "Measurement Period" return FaceToFaceEncounter
"Face to Face Encounter with Ongoing Chemotherapy"
"Radiation Treatment Management During Measurement Period with Cancer Diagnosis"
"Face to Face Encounter with Ongoing Chemotherapy" FaceToFaceEncounterWithChemo with ["Assessment, Performed": "Standardized Pain Assessment Tool"] PainAssessed such that PainAssessed.relevantDatetime during FaceToFaceEncounterWithChemo.relevantPeriod and PainAssessed.result is not null
"Radiation Treatment Management During Measurement Period with Cancer Diagnosis" RadiationTherapy with ["Assessment, Performed": "Standardized Pain Assessment Tool"] PainAssessed such that PainAssessed.relevantDatetime during RadiationTherapy.relevantPeriod and PainAssessed.result is not null
["Procedure, Performed": "Radiation Treatment Management"] RadiationTreatmentManagement with ["Diagnosis": "Cancer"] Cancer such that Cancer.prevalencePeriod overlaps RadiationTreatmentManagement.relevantPeriod where RadiationTreatmentManagement.relevantPeriod during "Measurement Period"
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
["Patient Characteristic Ethnicity": "Ethnicity"]
["Patient Characteristic Payer": "Payer"]
["Patient Characteristic Race": "Race"]
["Patient Characteristic Sex": "ONC Administrative Sex"]
Measure Set |
None |
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