eMeasure Title Prostate Cancer: Avoidance of Overuse of Bone Scan for Staging Low Risk Prostate Cancer Patients
eMeasure Identifier
(Measure Authoring Tool)
129 eMeasure Version number 2
NQF Number 0389 GUID 1635c14d-e612-4fa6-96cd-285361aa7f7b
Measurement Period January 1, 20xx through December 31, 20xx
Measure Steward American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Measure Developer American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
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
Copyright 2012 American Medical Association. All Rights Reserved.
Disclaimer
Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (the PCPI[TM]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, 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 Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. 

THE MEASURES AND SPECIFICATIONS ARE PROVIDED “AS IS” WITHOUT WARRANTY OF ANY KIND. 

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CPT(R) contained in the Measure specifications is copyright 2004-2011 American Medical Association. LOINC(R) copyright 2004-2011 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2011 International Health Terminology Standards Development Organisation. ICD-10 copyright 2011 World Health Organization. All Rights Reserved.

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Measure Scoring Proportion
Measure Type Process
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
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
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
Risk Strata Definitions: Low, Intermediate, or High –
Low Risk – PSA <= 10 ng/mL; AND Gleason score 6 or less; AND clinical stage T1c or T2a
Intermediate Risk – PSA > 10 to 20 ng/mL; OR Gleason score 7; OR clinical stage T2b, and not qualifying for high risk
High Risk – PSA > 20 ng/mL; OR Gleason score 8 to 10; OR clinical stage T2c or greater; and not qualifying for very high risk
Guidance
A higher score indicates appropriate treatment of patients with prostate cancer at low risk of recurrence.
Only patients with prostate cancer with low risk of recurrence with be counted in the performance denominator of this measure.
Transmission Format
TBD
Initial Patient Population
All patients, regardless of age, with a diagnosis of prostate cancer
Denominator
Equals Initial Patient Population at low risk of recurrence receiving interstitial prostate brachytherapy, OR external beam radiotherapy to the prostate, OR radical prostatectomy, OR cryotherapy
Denominator Exclusions
None
Numerator
Patients who did not have a bone scan performed at any time since diagnosis of prostate cancer
Numerator Exclusions
Not Applicable
Denominator Exceptions
Documentation of reason(s) for performing a bone scan (including documented pain, salvage therapy, other medical reasons, bone scan ordered by someone other than reporting physician)
Measure Population
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population criteria

Data criteria (QDM Data Elements)

Reporting Stratification

Supplemental Data Elements




Measure Set
None