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  • Measure Summary
  • NQMC:008569
  • Apr 2012

Chronic graft versus host disease (cGVHD): percentage of patients with symptomatic mild cGVHD with only local therapy prescribed.

Proposed chronic graft versus host disease measure set: questionnaire, measures with specifications, glossary. Arlington Heights (IL): American Society for Blood and Marrow Transplantation; 26 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2016.

Primary Measure Domain

Related Health Care Delivery Measures: Use of Services

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients with symptomatic mild chronic graft versus host disease (cGVHD) with only local therapy prescribed.

Rationale

The pathogenesis of chronic graft versus host disease (cGVHD) is poorly understood. Symptoms usually present within 3 years after allogeneic hematopoietic cell transplantation (HCT) and are often preceded by a history of acute GVHD. Manifestations of chronic GVHD may be restricted to a single organ or tissue or may be widespread. Chronic GVHD can lead to debilitating consequences, e.g., joint contractures, loss of sight, end-stage lung disease, or mortality resulting from profound chronic immune suppression leading to recurrent or life-threatening infections.

Support (verbatim) from National Institutes of Health (NIH) Consensus Development Project: Mild cGVHD involves only 1 or 2 organs or sites (except the lung), with no clinically significant functional impairment (maximum of score 1 in all affected organs or sites). Symptomatic mild chronic GVHD may often be treated with local therapies alone (e.g., topical steroids to the skin).

Statement (verbatim) from NIH Consensus Development Project on gap: The time-honored description of limited versus extensive chronic GVHD was proposed from only 20 cases published in 1980. The [NIH] Working Group proposes a new global assessment of chronic GVHD severity that is clinically suitable and is appropriate for use as an inclusion criterion in therapeutic clinical trials or as an indication for systemic immunosuppressive treatment.

Statement from the American Society for Blood and Marrow Transplantation (ASBMT) Task Force on gap: The use of systemic immunosuppressive therapy in cGVHD has been guided by a study published in 1980. Due to the release of new guidelines in 2005, we believe there is a gap in the use of local therapies in mild cGVHD. And due to the significant morbidity associated with immunosuppression, we believe closing this gap to be critical to improving transplant patient care.

Evidence for Rationale

Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, Martin P, Chien J, Przepiorka D, Couriel D, Cowen EW, Dinndorf P, Farrell A, Hartzman R, Henslee-Downey J, Jacobsohn D, McDonald G, Mittleman B, Rizzo JD, Robinson M, Schubert M, Schultz K, Shulman H, Turner M, Vogelsang G, Flowers ME. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005 Dec;11(12):945-56. PubMed External Web Site Policy

Proposed chronic graft versus host disease measure set: questionnaire, measures with specifications, glossary. Arlington Heights (IL): American Society for Blood and Marrow Transplantation; 26 p.

Shulman HM, Sullivan KM, Weiden PL, McDonald GB, Striker GE, Sale GE, Hackman R, Tsoi MS, Storb R, Thomas ED. Chronic graft-versus-host syndrome in man. A long-term clinicopathologic study of 20 Seattle patients. Am J Med. 1980 Aug;69(2):204-17. PubMed External Web Site Policy

Sullivan KM. Graft vs. host disease. In: Blume KG, Forman SJ, Appelbaum FR, editor(s). Thomas' Hematopoietic Cell Transplantation. 3rd ed. Malden (MA): Blackwell Publishing; 2004. p. 635-64.

Wolff D, Gerbitz A, Ayuk F, Kiani A, Hildebrandt GC, Vogelsang GB, Elad S, Lawitschka A, Socie G, Pavletic SZ, Holler E, Greinix H. Consensus conference on clinical practice in chronic graft-versus-host disease (GVHD): first-line and topical treatment of chronic GVHD. Biol Blood Marrow Transplant. 2010 Dec;16(12):1611-28. PubMed External Web Site Policy

Primary Health Components

Chronic graft versus host disease (cGVHD); symptomatic mild chronic GVHD; local therapy

Denominator Description

The number of patients in your selection diagnosed with chronic graft versus host disease (cGVHD) AND condition is considered mild (only 1 or 2 organ sites, maximum score of 1 in all affected organs/sites) AND symptomatic (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of patients in your selection diagnosed with chronic graft versus host disease (cGVHD) AND condition is considered mild (only 1 or 2 organ sites, maximum score of 1 in all affected organs/sites) AND symptomatic AND prescribed only local therapy (see the related "Numerator Inclusions/Exclusions" field)

Type of Evidence Supporting the Criterion of Quality for the Measure

  • 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

Reported incidence rates of chronic graft versus host disease (cGVHD) after allogeneic transplantation range from 6% to 80% according to recipient age, donor type, hematopoietic cell transplantation (HCT) source (peripheral blood, bone marrow, or umbilical cord blood stem cells), graft manipulation (T-cell depletion), and use of post transplantation donor lymphocyte infusion (DLIs). Reliable incidence estimates in different cohorts of HCT recipients are compromised by (1) lack of standardized, widely used diagnostic guidelines; (2) variability in observer experience; (3) limited expert follow-up at a distance from transplant centers; (4) differences in the statistical methods applied (e.g., use of the Kaplan-Meier versus cumulative incidence estimates and variable requirement for some minimal survival [60-100 days] for patients to be considered at risk of chronic GVHD); and (5) the sometimes protean nature of early chronic GVHD symptoms, which mimic alternative diagnoses.

Evidence for Additional Information Supporting Need for the Measure

Filipovich AH, Weisdorf D, Pavletic S, Socie G, Wingard JR, Lee SJ, Martin P, Chien J, Przepiorka D, Couriel D, Cowen EW, Dinndorf P, Farrell A, Hartzman R, Henslee-Downey J, Jacobsohn D, McDonald G, Mittleman B, Rizzo JD, Robinson M, Schubert M, Schultz K, Shulman H, Turner M, Vogelsang G, Flowers ME. National Institutes of Health consensus development project on criteria for clinical trials in chronic graft-versus-host disease: I. Diagnosis and staging working group report. Biol Blood Marrow Transplant. 2005 Dec;11(12):945-56. PubMed External Web Site Policy

Remberger M, Aschan J, Lonnqvist B, Carlens S, Gustafsson B, Hentschke P, Klaesson S, Mattsson J, Ljungman P, Ringden O. An ethnic role for chronic, but not acute, graft-versus-host disease after HLA-identical sibling stem cell transplantation. Eur J Haematol. 2001 Jan;66(1):50-6. PubMed External Web Site Policy

Rocha V, Wagner JE Jr, Sobocinski KA, Klein JP, Zhang MJ, Horowitz MM, Gluckman E. Graft-versus-host disease in children who have received a cord-blood or bone marrow transplant from an HLA-identical sibling. Eurocord and International Bone Marrow Transplant Registry Working Committee on Alternative Donor and Stem Cell Sources. N Engl J Med. 2000 Jun 22;342(25):1846-54. PubMed External Web Site Policy

Sullivan KM, Agura E, Anasetti C, Appelbaum F, Badger C, Bearman S, Erickson K, Flowers M, Hansen J, Loughran T, et al. Chronic graft-versus-host disease and other late complications of bone marrow transplantation. Semin Hematol. 1991 Jul;28(3):250-9. [75 references] PubMed External Web Site Policy

Extent of Measure Testing

The Chronic Graft Versus Host Disease (cGVHD) measure set was developed by the American Society for Blood and Marrow Transplantation (ASBMT) using a rigorous methodology (adapted from the American Medical Association's Physician Consortium for Performance Improvement [AMA-PCPI] and including field testing) and adapted for use in Practice Improvement Modules (PIMs) by the American Board of Internal Medicine (ABIM).

Evidence for Extent of Measure Testing

Joseph TL. (Executive Director, American Society for Blood and Marrow Transplantation). Personal communication. 2013 Jan 21.  1 p.

State of Use

Current routine use

Current Use

Certification

Internal quality improvement

Measurement Setting

Ambulatory/Office-based Care

Hospital Inpatient

Hospital Outpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Clinical Practice or Public Health Sites

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

All ages

Target Population Gender

Either male or female

National Quality Strategy Priority

Making Care Safer
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Safety

Case Finding Period

12 months

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
The number of patients in your selection diagnosed with chronic graft versus host disease (cGVHD) AND condition is considered mild (only 1 or 2 organ sites, maximum score of 1 in all affected organs/sites) AND symptomatic

Note: Patients can be included in the chart abstraction if:

  • They have been seen by the practice within the past 12 months; and
  • Management decisions regarding care are made primarily by providers in the practice.

Select at least 10 of your patients who have had hematopoietic cell transplant (HCT) and cGVHD. Refer to the original measure documentation for administrative codes.

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
The number of patients in your selection diagnosed with chronic graft versus host disease (cGVHD) AND condition is considered mild (only 1 or 2 organ sites, maximum score of 1 in all affected organs/sites) AND symptomatic AND prescribed only local therapy

Note: This requires documentation in the patient's medical record that the user had determined the patient's cGVHD to be mild, symptoms that were experienced by the patient and that local therapy was prescribed (see the original measure documentation for details).

Exclusions
None

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

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

Does not apply to this measure (i.e., there is no pre-defined preference for the measure score)

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Patients with symptomatic mild chronic GVHD with only local therapy prescribed.

Measure Collection Name

Chronic Graft Versus Host Disease Measure Set

Submitter

American Society for Blood and Marrow Transplantation - Professional Association

Developer

American Society for Blood and Marrow Transplantation - Professional Association

Funding Source(s)

American Society for Blood and Marrow Transplantation

Composition of the Group that Developed the Measure

The American Society for Blood and Marrow Transplantation (ASBMT) Education Practice Improvement Modules Task Force:

  • Linda Burns, MD (chair)
  • Stephan A Grupp, MD, PhD
  • Mark B Juckett, MD
  • Vivek Roy, MD
  • Edward Agura, MD
  • Miguel-Angel Perales, MD
  • Thomas Joseph, MPS, CAE, ASBMT Executive Director
  • Sue Frechette, BSN, MBA Consultant

Financial Disclosures/Other Potential Conflicts of Interest

Conflicts, if any, are disclosed in accordance with the American Society for Blood and Marrow Transplantation (ASBMT) conflict of interest policy.

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2012 Apr

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2016.

Source(s)

Proposed chronic graft versus host disease measure set: questionnaire, measures with specifications, glossary. Arlington Heights (IL): American Society for Blood and Marrow Transplantation; 26 p.

Measure Availability

Source not available electronically.

For more information, contact the American Society for Blood and Marrow Transplantation (ASBMT) at 85 W. Algonquin Road, Suite 550, Arlington Heights, IL 60005; Phone: 847-427-0224; Fax: 847-427-9656; Web site: www.asbmt.org External Web Site Policy; E-mail: mail@asbmt.org.

NQMC Status

This NQMC summary was completed by ECRI Institute on September 24, 2013. The information was verified by the measure developer on October 25, 2013.

The information was reaffirmed by the measure developer on February 4, 2016.

Copyright Statement

This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.

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