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The Importance of EHR Quality Measures & Colorectal Cancer Screening

Lou is a 52 year old man in good health who sees his physician, Dr. Spencer, yearly for check-ups. During Lou's most recent visit, Dr. Spencer noticed Lou had not been screened for colorectal cancer. Dr. Spencer knows patients can find this screening uncomfortable, and so considers different screening options. He reviews fecal occult blood testing (FOBT), flexible sigmoidoscopy, double contract barium enema (DCBE), and colonoscopy treatment before deciding to order an FOBT for Lou.

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

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

  • A randomized trial that investigated the effectiveness of fecal occult blood testing found:1
    • Annual FOBT decreased the 13 year mortality from colorectal cancer by 33 percent
  • A randomized controlled trial of 154,900 participants following over 13 years found:2
    • Patients given a flexible sigmoidoscopy had 26% reduction in relative risk of death from colorectal cancer when compared with those given usual care.
    • Patients given a flexible sigmoidoscopy had a 21% reduction in relative risk of incidence of colorectal cancer when compared with those given usual care.
  • Microsimulation models used to estimate the life-years gained relative to no screening found:3
    • A colonoscopy every ten years for those aged 50 – 75 results in 27 life years gained per 1,000

Conclusion

If Lou and Dr. Spencer complete colorectal cancer screenings as recommended, Lou's chances of dying from colorectal cancer will be substantially reduced and he will hopefully enjoy many more healthy years of life.

Clinical Quality Measure Information

Colorectal Cancer Screening

NQF# Description Numerator Denominator Exclusions
NQF# Not Applicable Percentage of members 50-75 years of age who had appropriate screening for colorectal cancer All patients who have at least of the following:
  • FOBT during the measurement year; or
  • Flexible sigmoidoscopy during the measurement of the four years prior; or
  • DCBE during the measurement year or the four years prior; or
  • Colonoscopy during the measurement year or the nine years prior.
 Patients who:
  • Are aged 51-75 years as of December 31st of the measurement year.
 Patients with:
  • A diagnosis of colon cancer
  • A total colectomy

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.4

  1. Mandel JS, Bond JH, Church TR, Bradley GM, Schuman LM, Ederer F. “Reducing Mortality from Colorectal Cancer by Screening for Fecal Occult Blood”. The New England Journal of Medicine. 1993 (328, 19): 1365-71
  2. Schoen RE, Pinksy PF, Weissfeld JL, Yokochi, LA, Church T, Laiyemo AO, Braselier R, Andriole GL, Buys SS, Crawford ED, Fouad MN, Issacs C, Johnson CC, Reding DJ, O’Brien B, Carrick DM, Wright P, Riley TL, Purdue MP, Izmirlian G, Kramer BS, Miller AB, Gohogan, JK, Prorok PC, Berg CD. “Colorectal Cancer Incidence and Mortality With Screening Flexible Sigmoidoscopy”. The New England Journal of Medicine. 2012 (366, 25): 2345- 57
  3. Zauber AG, Lansdorp-Vogelaar I, Knudsen AB, Wilschut J, van Ballegoojian M, Kuntz KM. “Evaluation test strategies for colorectal cancer screening: a decision analysis for the US Preventive Services Task Force”. Annals of Internal Medicine, 149 (2008) 9: 659-69
  4. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org]. Accessed December 6, 2011

Produced by Meaningful Use Quality Workgroup – March 22, 2013

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