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The Importance of EHR Quality Measures & Breast Cancer Screening


Jacqui is a 52 year old married woman who presents for her annual physical examination. Her doctor, Dr. Mackewicz, referred her for a mammogram at last year’s visit but Jacqui never followed through. She expresses anxiety about, and discomfort with, the procedure as reasons for not receiving one and states she does breast self-exams every few months. Dr. Mackiewicz and his staff work with Jacqui to address her concerns and again refer her for a mammogram.1

Which Breast Cancer Screening Measures Count for Meaningful Use (Stage 1 & Stage 2)?

Measuring & Improving Breast Cancer Screening: A Real Impact on Your Patients

  • A randomized Swedish study of 133,065 women between the ages of 40 and 74 that compared those who were invited to breast cancer screening with those who received usual care found:2
    • Women invited to screen had 0.69 times the risk of death than those who received usual care (p<0.0001);
    • For every 1,667 breast cancer screenings 1 life is saved;
    • The relative benefit in breast cancer mortality from mammographic screening remains steady up to 29 years after screening is initiated; and
    • The absolute number of breast cancer deaths prevented increases with follow-up time.
  • A study that looked both at the Swedish randomized study and England’s breast cancer screening program found:3
    • 5.7 to 8.8 breast cancer deaths were prevented per 1,000 women screened for 20 years from age 50;
    • Only 2.3 to 4.3 breast cancer cases were over-diagnosed per 1,000 over 20 years; and
    • The benefit in terms of lives saved is double the harm caused by misdiagnosis.
  • The CDC's Health, United States, 2011 report states:4
    • Between 2000 and 2010 only 60-70% of women aged 40 years or older had received a mammogram in the past two years; and
    • In 2010, 73% of those over 50, and 64% of those over 65, reported having had a mammogram in the past two years.

Conclusion

Helping Jacqui complete her recommended mammogram can help her identify breast cancer early and significantly increase her chance of surviving. This will allow Jacqui more quality years with her family.

Clinical Quality Measure Information

Breast Cancer Screening (this measure is no longer NQF endorsed)

NQF# Description Numerator Denominator Exclusions
2372 Percentage of women 40-69 years of age who had a mammogram to screen for breast cancer. Women with:
  • ≥ 1 mammogram during the measurement period or the year prior to the measurement period
Patients
  • 42-69 years of age
Patients with:
  • A mastectomy

About National Quality Forum (NQF) Endorsement

Each of the Clinical Quality Measures has an NQF number, indicating that it has received endorsement from the National Quality Forum (NQF), a nonprofit organization with the mission to improve the quality of American healthcare. NQF uses a formal Consensus Development Process (CDP) to evaluate and endorse consensus standards, including performance measures. This process includes gathering input on performance measures from a wide variety of stakeholders including consumer organizations and health care providers.6 This measure is no longer endorsed by the NQF, but remains an applicable Meaningful Use Clinical Quality Measure.

  1. Adapted from the following: http://c.ymcdn.com/sites/www.aptrweb.org/resource/resmgr/prevention_modules/discussionvignette-mammogram.pdf Exit Disclaimer [c.ymcdn.com] Accessed 10.29.12
  2. Taber L, Vitak B, Chen TH, Yen AM, Cohen A, Tot T, Chiu SY, Chen SY, Rosell J, Fohlin H, Smith RA, Duffy SW. "Swedish two-county trial: Impact of mammographic screening on breast cancer mortality during 3 decades". Radiology. 260 (2011): 658-63.
  3. Duffy SW, Tabar L, Olsen AH, Vitak B, Allgood PC, Chen THH, Yen AMF, Smith RA. "Absolute numbers of lives saved and over-diagnosis in breast cancer screening, from a randomized trial and from the Breast Cancer Screening Programme in England". Journal of Medical Screening. 17 (2010): 25-30.
  4. Health, United States, 2011. Centers for Disease Control. http://www.cdc.gov/nchs/hus/women.htm#preventive. Table #90. Accessed 10.30.12.
  5. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup – March 22, 2013
*This measure is no longer NQF endorsed

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