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  • Measure Summary
  • NQMC:011223
  • Jul 2016

Breast cancer: proportion of patients with breast cancer under 30 years of age referred to a specialist clinic for genetic testing.

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 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 breast cancer under 30 years of age referred to a specialist clinic for genetic testing.

This Cancer Quality Performance Indicator (QPI) is separated into two parts. Please refer to the related NQMC measure summary, Breast cancer: proportion of patients with triple negative breast cancer under 40 years of age referred to a specialist clinic for genetic testing.

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

Where patients have breast cancer, genetic testing should be offered if their combined BRCA1 and BRCA2 mutation carrier probability is greater than or equal to 10% (National Institute for Health and Care Excellence [NICE], 2013).

Various prediction models exist to assess the likelihood of a BRCA1 or BRCA2 mutation in a family. All patients with triple negative breast cancer who are under 40 years of age would be predicted to have greater than or equal to 10% probability of a BRCA1 or BRCA2 mutation. Breast cancer in patients under 30 years of age also increases the likelihood of a BRCA1/BRCA2 or p53 mutation.

Some patients may choose not to be seen at genetics services following referral. The measurement of this Cancer Quality Performance Indicator (QPI) therefore focuses on whether the appropriate patients are being referred to ensure equitable access to the service.

It is difficult to accurately capture data for all eligibility criteria for gene testing within current systems, therefore measurement of this QPI will focus on patients under 30 years of age and patients under 40 years of age with triple negative breast cancer in the first instance. This will be kept under review and revised as necessary when further data becomes available.

Evidence for Rationale

National Institute for Health and Clinical Excellence (NICE). Familial breast cancer: classification, care and managing breast cancer and related risks in people with a family history of breast cancer. London (UK): National Institute for Health and Clinical Excellence (NICE); 2013 Jun 25. 48 p.  (Clinical guideline; no. 164).

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Primary Health Components

Breast cancer; genetic testing; specialist clinic

Denominator Description

All patients with breast cancer who are under 30 years of age

Numerator Description

Number of patients with breast cancer under 30 years of age referred to a specialist clinic for genetic testing

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

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 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

Ambulatory/Office-based Care

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

Age less than 30 years

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

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with breast cancer who are under 30 years of age

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
Number of patients with breast cancer under 30 years of age referred to a specialist clinic for genetic testing

Exclusions
None

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: 90%

The target tolerance level accounts for patients who refuse referral.

Note: Varying evidence exists regarding the most appropriate target level therefore this may need redefined in the future, to take account of new evidence or as further data becomes available.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 references]

Original Title

QPI 14 (i) – referral for genetics testing.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Breast 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

Breast 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 Jul

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

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Breast cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Jul. 37 p. [21 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 June 7, 2017.

Copyright Statement

No copyright restrictions apply.

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