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  • Measure Summary
  • NQMC:010471
  • Jan 2016

Hepatitis C: percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis who underwent imaging with either ultrasound, contrast enhanced CT or MRI for hepatocellular carcinoma (HCC) at least once within the 12 month reporting period.

American Gastroenterological Association (AGA). Hepatitis C measures group overview. Bethesda (MD): American Gastroenterological Association (AGA); 2016 Jan. 17 p.

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2017.

Measure Hierarchy

Hepatitis C

Age Group

UMLS Concepts (what is this?)

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the percentage of patients aged 18 years and older with a diagnosis of chronic hepatitis C cirrhosis who underwent imaging with either ultrasound, contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI) for hepatocellular carcinoma (HCC) at least once within the 12 month reporting period.

Rationale

Hepatocellular carcinoma (HCC) is the fourth most common cancer in the world and is the fastest rising cause of cancer-related deaths in the United States. Hepatitis C virus (HCV) is the leading cause of HCC and the risk of developing HCC is highest in patients with established HCV cirrhosis.

Several potentially curative treatments are available for patients with early-stage HCC. These include surgical resection, liver transplantation, and local ablation. Long-term survival of patients who have liver resection or transplantation for HCC can be high (40% to 70% for resection and 52% to 81% for transplant patients after 5 years) (Kansagara et al., 2014).

A recent systematic review of 18 nonrandomized studies found that screened patients had early-stage HCC than clinically diagnosed patients. More screened patients received potentially curative treatment. However, these studies were limited by their observational nature (including lead time bias) and thus the effect on overall mortality was unclear. There are no randomized controlled trials that evaluated the impact of HCC screening versus no screening on survival in patients with cirrhosis. A randomized trial of HCC screening is not forthcoming because, even in the absence of high quality data, most informed patients and their clinicians consider randomization unethical and prefer surveillance (Poustchi et al., 2011). In a recent modeling based study (that corrected for lead time bias), ultrasound (US) based screening for HCC in compensated HCV cirrhosis patients reduced mortality compared to no screening (Mourad et al., 2014).

Collectively, these data suggest that screening has a potential to produce benefits in the highest-risk patients, such as those with HCV cirrhosis who are good candidates for potentially curative treatment (Atkins, Ross, & Kelley, 2014).

Clinical Recommendation Statements:

Patients at high risk for developing HCC, including patients with hepatitis C cirrhosis, should be entered into surveillance programs. Surveillance for HCC should be performed using ultrasonography. Patients should be screened at 6-month intervals (Bruix, Sherman, & American Association for the Study of Liver Diseases, 2011).

HCC surveillance must be continued indefinitely in patients with cirrhosis. Patients with cirrhosis should undergo regular surveillance for HCC, irrespective of sustained virologic response (SVR) (European Association for the Study of the Liver, 2014).

While current guidelines only specify using ultrasound, evidence suggests that using multiple screening methods, including incorporating the alpha fetoprotein biomarker into surveillance plans, may be more effective in identifying early stages of HCC.

Evidence for Rationale

American Gastroenterological Association (AGA). Hepatitis C measures group overview. Bethesda (MD): American Gastroenterological Association (AGA); 2016 Jan. 17 p.

Atkins D, Ross D, Kelley M. Acting in the face of uncertainty. Ann Intern Med. 2014 Aug 19;161(4):300-1.

Bruix J, Sherman M, American Association for the Study of Liver Diseases. Management of hepatocellular carcinoma: an update. Hepatology. 2011 Mar;53(3):1020-2. PubMed External Web Site Policy

European Association for the Study of Liver (EASL). EASL recommendations on treatment of hepatitis C. Geneva (Switzerland): European Association for the Study of Liver (EASL); 2014 Apr. 20 p. [98 references]

Kansagara D, Papak J, Pasha AS, O'Neil M, Freeman M, Relevo R, Quiñones A, Motu'apuaka M, Jou JH. Screening for hepatocellular carcinoma in chronic liver disease: a systematic review. Ann Intern Med. 2014 Aug 19;161(4):261-9.

Mourad A, Deuffic-Burban S, Ganne-Carrié N, Renaut-Vantroys T, Rosa I, Bouvier AM, Launoy G, Cattan S, Louvet A, Dharancy S, Trinchet JC, Yazdanpanah Y, Mathurin P. Hepatocellular carcinoma screening in patients with compensated hepatitis C virus (HCV)-related cirrhosis aware of their HCV status improves survival: a modeling approach. Hepatology. 2014 Apr;59(4):1471-81.

Poustchi H, Farrell GC, Strasser SI, Lee AU, McCaughan GW, George J. Feasibility of conducting a randomized control trial for liver cancer screening: is a randomized controlled trial for liver cancer screening feasible or still needed?. Hepatology. 2011 Dec;54(6):1998-2004.

Primary Health Components

Chronic hepatitis C virus (HCV); cirrhosis; hepatocellular carcinoma (HCC); ultrasound (US); contrast enhanced computed tomography (CT); magnetic resonance imaging (MRI)

Denominator Description

Patients aged 18 years and older with a specific diagnosis of chronic hepatitis C cirrhosis (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Patients who underwent abdominal imaging with either ultrasound, contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI) (see the related "Numerator Inclusion/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 systematic review of the clinical research literature (e.g., Cochrane Review)
  • 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

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Pay-for-reporting

Public reporting

Measurement Setting

Ambulatory/Office-based Care

Ambulatory Procedure/Imaging Center

Professionals Involved in Delivery of Health Services

Physicians

Least Aggregated Level of Services Delivery Addressed

Individual Clinicians or Public Health Professionals

Statement of Acceptable Minimum Sample Size

Specified

Target Population Age

Age greater than or equal to 18 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

The reporting period (January 1 through December 31)

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
Patients aged 18 years and older with a specific diagnosis of chronic hepatitis C cirrhosis

Denominator Criteria (Eligible Cases):

Patients aged greater than or equal to 18 years on date of encounter

AND

One of the following diagnosis codes indicating chronic hepatitis C (International Classification of Diseases, Tenth Revision, Clinical Modification [ICD-10-CM] codes): B18.2, B19.20, B19.21

AND

One of the following diagnosis code indicating cirrhosis (ICD-10-CM codes): K70.30, K70.31, K74.60, K74.69

AND

Patient encounter during the reporting period (refer to the original measure documentation for specific Current Procedural Terminology [CPT] codes)

Exclusions
None

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Patients who underwent abdominal imaging with either ultrasound, contrast enhanced computed tomography (CT) or magnetic resonance imaging (MRI)

Exclusions
Documentation of medical or patient reason(s) for not ordering or performing screening for hepatocellular carcinoma (HCC):

  • Medical Reasons: comorbid medical conditions with expected survival less than 5 years, hepatic decompensation and not a candidate for liver transplantation, or other medical reasons.
  • Patient Reasons: patient declined or other patient reasons (e.g., cost of tests, time related to accessing testing equipment)

Numerator Search Strategy

Fixed time period or point in time

Data Source

Administrative clinical data

Registry data

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

Internal time comparison

Original Title

Measure #401: screening for hepatocellular carcinoma (HCC) in patients with hepatitis C cirrhosis.

Measure Collection Name

Hepatitis C

Submitter

American Gastroenterological Association - Medical Specialty Society

Developer

American Gastroenterological Association - Medical Specialty Society

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Unspecified

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Core Quality Measures

Gastroenterology

HIV and Hepatitis C

Measure Initiative(s)

Physician Quality Reporting System

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Jan

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

2017

Measure Status

This is the current release of the measure.

The measure developer reaffirmed the currency of this measure in February 2017.

Source(s)

American Gastroenterological Association (AGA). Hepatitis C measures group overview. Bethesda (MD): American Gastroenterological Association (AGA); 2016 Jan. 17 p.

Measure Availability

Source not available electronically.

For more information, contact the American Gastroenterological Association (AGA) at 4930 Del Ray Avenue, Bethesda, MD 20814; Phone: 301-654-2055; Fax: 301-654-5920; E-mail: measures@gastro.org; Web site: www.gastro.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on March 14, 2016. The information was verified by the measure developer on March 29, 2016.

The information was reaffirmed by the measure developer on February 6, 2017.

Copyright Statement

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

Physician Performance Measures (Measures) and related data specifications have been developed by the American Gastroenterological Association (AGA) Institute.

These performance Measures are not clinical guidelines and do not establish a standard of medical care, nor have been tested for all potential applications. Neither the AGA, any of its affiliates, the American Medical Association (AMA), the Physician Consortium for Performance Improvement (PCPI™), nor its members shall be responsible for any use of the Measures.

Measures are subject to review and may be revised or rescinded at any time by the AGA. The Measures may not be altered without the prior written approval of the AGA. Measures developed by the AGA, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, e.g., use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AGA.

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND

2015 American Gastroenterological Association. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AGA, its affiliates, AMA the PCPI and its members disclaim all liability for use or accuracy of any current procedural terminology (CPT) or other coding contained in the specifications. CPT® contained in the Measures specifications is copyright 2004.

2015 American Medical Association. LOINC is copyright 2004

2015 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms (SNOMED CT) copyright 2004

2015 International Health Terminology Standards Development Organization. All Rights Reserved.

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