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  • Measure Summary
  • NQMC:011072
  • Jun 2016

Bladder cancer: proportion of patients with bladder cancer who undergo transurethral resection of bladder tumour (TURBT) where it is documented whether the resection was complete or not at initial resection.

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients with bladder cancer who undergo transurethral resection of bladder tumour (TURBT) where it is documented whether the resection was complete or not at initial resection.

This Cancer Quality Performance Indicator (QPI) measure is separated into three parts. Please refer to the following related NQMC summaries:

Note from the National Quality Measures Clearinghouse: This measure is part of the QPIs collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

Transurethral resection of bladder tumour (TURBT) is considered to be the gold standard initial treatment of non muscle invasive bladder cancer (NMIBC), with the aim of completely removing all macroscopic tumours and obtaining tissue for essential pathological evaluation (Bladder Cancer Clinical Guideline Update Panel, 2007). Although the 10-year disease specific survival for Ta and T1 NMIBC is 85% and 70% (Lamm et al., 2008) respectively; the risk of recurrence is as high as 70% (Bladder Cancer Clinical Guideline Update Panel, 2007). Most recurrences are detected at the first check cystoscopy following initial TURBT and therefore attributable to residual disease or missed tumours at initial TURBT. These recurrences have been shown to vary according to the quality of the initial TURBT (Brausi et al., 2002). Several surgical factors have hence been found to be associated with a good quality TURBT, thereby have been shown to be a surrogate for quality of TURBT. These factors have been incorporated into this Cancer Quality Performance Indicator (QPI).

It is recommended that a TURBT is performed in a systematic manner, a complete resection with detrusor muscle in the sample is the ultimate aim (The Dutch Society for Urology, 2009). Adequate documentation (use of a bladder diagram) with a conclusion regarding radicality or residual tumour is recommended (Babjuk et al., 2011; The Dutch Society for Urology, 2009).

The procedure should be carried out by an experienced surgeon, and when carried out by a trainee this should be under supervision of an experienced operator.

Evidence for Rationale

Babjuk M, Oosterlinck W, Sylvester R, Kaasinen E, Böhle A, Palou-Redorta J, Rouprêt M, European Association of Urology (EAU). EAU guidelines on non-muscle-invasive urothelial carcinoma of the bladder, the 2011 update. Eur Urol. 2011 Jun;59(6):997-1008. PubMed External Web Site Policy

Bladder Cancer Clinical Guideline Update Panel. Guideline for the management of nonmuscle invasive bladder cancer: (stages Ta, T1, and Tis): 2007 update. Linthicum (MD): American Urological Association Education and Research, Inc; 2007. 133 p. [31 references]

Brausi M, Collette L, Kurth K, van der Meijden AP, Oosterlinck W, Witjes JA, Newling D, Bouffioux C, Sylvester RJ, EORTC Genito-Urinary Tract Cancer Collaborative Group. Variability in the recurrence rate at the first follow up cystoscopy after TUR in stage TaT1 transitional cell carcinoma of the bladder: a combined analysis of seven EORTC studies. Eur Urol. 2002 May;41(5):523-31. PubMed External Web Site Policy

Lamm D, Colombel M, Persad R, Soloway M, Bohle A, Palou J, Witjes JA, Akaza H, Buckley R, Brausi M. Clinical practice recommendations for the management of non-muscle invasive bladder cancer. Eur Urol Suppl. 2008;7(2008):651-66. [72 references]

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

The Dutch Society for Urology. Bladder carcinoma. Utrecht (The Netherlands): Comprehensive Cancer Centre the Netherlands; 2009 Feb 13. 128 p.

Primary Health Components

Bladder cancer; transurethral resection of bladder tumour (TURBT); complete resection

Denominator Description

All patients with bladder cancer who undergo transurethral resection of bladder tumour (TURBT) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with bladder cancer who undergo transurethral resection of bladder tumour (TURBT) where it is documented whether the resection was complete or not at initial resection (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by the Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

Unspecified

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Getting Better

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with bladder cancer who undergo transurethral resection of bladder tumour (TURBT)

Exclusions

  • Patients undergoing palliative resection
  • Patients with very small tumours (less than or equal to 5 mm)

Exclusions/Exceptions

Medical factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of patients with bladder cancer who undergo transurethral resection of bladder tumour (TURBT) where it is documented whether the resection was complete or not at initial resection

Exclusions

  • Patients undergoing palliative resection
  • Patients with very small tumours (less than or equal to 5 mm)

Numerator Search Strategy

Fixed time period or point in time

Data Source

Electronic health/medical record

Paper medical record

Type of Health State

Does not apply to this measure

Instruments Used and/or Associated with the Measure

Unspecified

Measure Specifies Disaggregation

Does not apply to this measure

Scoring

Rate/Proportion

Interpretation of Score

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 80%

The tolerance within this target level accounts for the fact that it is not always possible to include detrusor muscle within the specimen.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

Original Title

QPI 2 (ii) – quality of transurethral resection of bladder tumour recording.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Bladder Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Bladder Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jun

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

2018 Feb

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Bladder cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jun. 38 p. [19 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 3, 2017. The information was verified by the measure developer on May 23, 2017.

Copyright Statement

No copyright restrictions apply.

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