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The Importance of EHR Quality Measures & Women's Health


Claire is a 22 year old college student who hasn't seen a doctor in almost 5 years. She visits Dr. Fishman for an initial appointment and asks if she is accepting additional new patients. Claire's 52 year old mother has also not seen a doctor in some time, which has Claire concerned. After talking with Claire and learning she has a new boyfriend with whom she is sexually active, Dr. Fishman screens her for both cervical cancer and chlamydia. Dr. Fishman also schedules an appointment to see Claire's mother, who will be screened for cervical cancer and referred for a mammogram.

Which Women's Health Measures Count for Meaningful Use (Stage 1 & Stage 2)

Measuring & Improving Women's Health: 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:1
    • 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 Swedish population based cohort study of 1,230 women followed over an average of 8.5 years found:2
    • Women who have cervical cancer diagnosed by a Pap smear have a 26% better cure rate (95% CI: 16-36) than those whose cancer is detected by symptoms, and the difference is not attributable to lead time bias.
  • The CDC's Health, United States, 2011 report states:3
    • In 2010, 73% of those over 50, and 64% of those over 65, reported having had a mammogram in the past two years.
    • In 2010, 85% of those aged 25-44, and 77% of those aged 45-64, reported having had a Pap smear in the past three years
    • Each kilogram of weight lost was associated with a 0.015 mmol/L decrease in triglycerides
  • A study of 13,204 female military recruits from 50 states reported that:4
    • A chlamydia screening program for those 25 years old or less would have identified 95% of infections
  • A randomized controlled study of 2,607 women found::5
    • Women were screened for chlamydia had 0.42 times the odds of developing Pelvic Inflammatory disease than those who received usual care.

Conclusion

Dr. Fishman can help both Claire and her mother have much better health outcomes by providing recommended women's health screenings. This will allow each of them more quality years of life to spend with each other and the rest of their family.

*This measure is no longer NQF endorsed, likely because ACS6 and USPTF7 have opposing recommendations on the initial age for mammography. Current consensus suggests a shared decision-making approach that incorporates individual breast cancer risk and patient's values

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

Cervical Cancer Screening

NQF# Description Numerator Denominator Exclusions
0032 Percentage of women 21-64 years of age who received one or more Pap tests to screen for cervical cancer. Women with:
  • > 1 Pap test during the measurement period or the 2 years prior to the measurement period
Women:
  • 24-64 years of age with a visit during the measurement period
Patients with:
  • A hysterectomy and without a residual cervix (optional exclusion)

Chlamydia Screening in Women

NQF# Description Numerator Denominator Exclusions
0033 Percentage of women 16-24 years of age who were identified as sexually active and who had at least one test for Chlamydia during the measurement year. Women with:
  • > Chlamydia test during the measurement year
Women:
  • 16-24 years of age who are sexually active
Patients with:
  • A pregnancy test during the measurement year followed within 7 days by either a prescription for isotretinoin or an x-ray.

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.9 Breast Cancer Screening is no longer endorsed by the NQF, but remains an applicable Meaningful Use Clinical Quality Measure.

  1. 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.
  2. Andre B, Andersson TML, Lambert PC, Kemetli L, Silfverdal L, Strander B, Ryd W, Dillner J, Tornberg S, Sparen P. "Screening and cervical cancer cure: population based cohort study". BMJ. 344 (2012) e900: 1-11.
  3. Health, United States, 2011. Centers for Disease Control. http://www.cdc.gov/nchs/hus/women.htm#preventive . Table #90 & 91. Accessed 10.30.12.
  4. Gaydos CA, Howell MR, Pare B, Clark KL, Ellis DA, Hendrix RM, Gaydos JC, McKee KT, Quinn TC. "Chlamydia Trachomatis infections in female military recruits". NEJM. 339 (2008) 11: 739-44.
  5. Scholes D, Stergachis A, Heidrich FE, Andrilla H, Holmes KK, Stamm WE. "Prevention of Pelvic Inflammatory Disease by screening for cervical chlamydial infection". NEJM. 334 (1996) 21: 1362-66
  6. American Cancer Society, Breast Cancer Screening: http://www.cancer.org/acs/groups/cid/documents/webcontent/003165-pdf.pdf Exit Disclaimer [www.cancer.org] Accessed January 31, 2012
  7. USPSTF Guidelines: Breast Cancer Screening http://www.uspreventiveservicestaskforce.org/uspstf/uspsbrca.htm Exit Disclaimer [www.uspreventiveservicestaskforce.org]Accessed October 31, 2012
  8. http://www.qualityforum.org Exit Disclaimer [www.qualityforum.org] Accessed January 31, 2012

Produced by Meaningful Use Quality Workgroup - March 22, 2013

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