Skip to main content

The AHRQ National Quality Measures Clearinghouse (NQMC, qualitymeasures.ahrq.gov) Web site will not be available after July 16, 2018 because federal funding
through AHRQ will no longer be available to support the NQMC as of that date. For additional information, read our full announcement.
  • Measure Summary
  • NQMC:011022
  • Feb 2017

Myelodysplastic syndromes (MDS): percentage of higher-risk MDS patients receiving azacitidine or decitabine.

American Society of Hematology (ASH). Myelodysplastic syndromes (MDS) measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 14 p.

This is the current release of the measure.

This measure updates a previous version: American Society of Hematology (ASH). Myelodysplastic syndromes (MDS) measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2015 Dec. 16 p.

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 higher-risk (intermediate-2, or high-risk using International Prognostic Scoring System [IPSS], very high-risk using IPSS-R, and/or with excess blasts, or high- or very high-risk using World Health Organization-based Prognostic Scoring System [WPSS]) myelodysplastic syndromes (MDS) patients greater than 18 years old receiving azacitidine or decitabine.

Rationale

Statement from the Myelodysplastic Syndromes (MDS) Task Force:
Recently revised National Comprehensive Cancer Network (NCCN) guidelines for MDS (2015) recommend the use of azacitidine or decitabine within the algorithm for the treatment of higher-risk MDS patients. The definition of higher risk patient was expanded to include World Health Organization-based Prognostic Scoring System (WPSS) High and Very High in 2014.

Excerpts (verbatim) from guidelines:
[Conventional d]rug treatments for patients with high-risk myelodysplastic syndromes provide no survival advantage. In this trial, we aimed to assess the effect of azacitidine on overall survival compared with the three commonest conventional care regimens… Treatment with azacitidine increases overall survival in patients with higher-risk myelodysplastic syndromes relative to conventional care (Fenaux et al., 2009).

[In a study to compare low-dose decitabine to best supportive care (BSC) in higher-risk patients with myelodysplastic syndrome (MDS) age 60 years or older and ineligible for intensive chemotherapy…] Decitabine administered in 6-week cycles is active in older patients with higher-risk MDS, resulting in improvements of OS [overall survival] and AMLFS [acute myeloid leukemia-free survival] (nonsignificant), of PFS [progression-free survival] and AML transformation (significant), and of QOL [quality of life] (Lübbert et al., 2011).

Evidence for Rationale

American Society of Hematology (ASH). Myelodysplastic syndromes (MDS) measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 14 p.

Fenaux P, Mufti GJ, Hellstrom-Lindberg E, Santini V, Finelli C, Giagounidis A, Schoch R, Gattermann N, Sanz G, List A, Gore SD, Seymour JF, Bennett JM, Byrd J, Backstrom J, Zimmerman L, McKenzie D, Beach C, Silverman LR, International Vidaza High-Risk MDS Survival Study Group. Efficacy of azacitidine compared with that of conventional care regimens in the treatment of higher-risk myelodysplastic syndromes: a randomised, open-label, phase III study. Lancet Oncol. 2009 Mar;10(3):223-32. PubMed External Web Site Policy

Lübbert M, Suciu S, Baila L, Rüter BH, Platzbecker U, Giagounidis A, Selleslag D, Labar B, Germing U, Salih HR, Beeldens F, Muus P, Pflüger KH, Coens C, Hagemeijer A, Eckart Schaefer H, Ganser A, Aul C, de Witte T, Wijermans PW. Low-dose decitabine versus best supportive care in elderly patients with intermediate- or high-risk myelodysplastic syndrome (MDS) ineligible for intensive chemotherapy: final results of the randomized phase III study of the European Organisation for Research and Treatment of Cancer Leukemia Group and the German MDS Study Group. J Clin Oncol. 2011 May 20;29(15):1987-96. PubMed External Web Site Policy

National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: myelodysplastic syndromes. V1.2016. Fort Washington (PA): National Comprehensive Cancer Network (NCCN); 2015 May 28.

Primary Health Components

Higher-risk myelodysplastic syndromes (MDS); International Prognostic Scoring System (IPSS, IPSS-R); World Health Organization-Based Prognostic Scoring System (WPSS); azacitidine; decitabine

Denominator Description

The number of myelodysplastic syndromes (MDS) patients in your selection who are higher-risk (intermediate-2, or high-risk using International Prognostic Scoring System [IPSS], very high-risk using IPSS-R, and/or with excess blasts, or high- or very high-risk using World Health Organization-based Prognostic Scoring System [WPSS])

See the related "Denominator Inclusions/Exclusions" field.

Numerator Description

The number of myelodysplastic syndromes (MDS) patients in your selection who are

  • Higher-risk (intermediate-2, or high-risk using International Prognostic Scoring System [IPSS], very high-risk using IPSS-R, and/or with excess blasts, or high- or very high-risk using World Health Organization-based Prognostic Scoring System [WPSS])

    AND

  • Receiving azacitidine or decitabine

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
  • One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal

Additional Information Supporting Need for the Measure

Evidence of gap:
The use of azacitidine or decitabine for the treatment of higher-risk myelodysplastic syndromes (MDS) is a recent addition to the National Comprehensive Cancer Network (NCCN) guidelines. For this reason, we believe there is a gap in use of these therapeutic options. Since 2013, performance for this measure was 79% for 203 patients.

Evidence for Additional Information Supporting Need for the Measure

American Society of Hematology (ASH). Myelodysplastic syndromes (MDS) measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 14 p.

Extent of Measure Testing

The myelodysplastic syndromes (MDS) measure set was developed by the American Society of Hematology (ASH) using a rigorous methodology (adapted from the American Medical Association [AMA]-convened Physician Consortium for Performance Improvement [PCPI]) and has been field tested. The MDS measure set was accepted by American Board of Internal Medicine (ABIM) for use with practice improvement modules meeting Part 4 of Maintenance of Certification Requirements in 2006.

Evidence for Extent of Measure Testing

Frechette S. (Principal, Northfield Associates, LLC, Warren, VT). Personal communication. 2014 Dec 10.  1 p.

State of Use

Current routine use

Current Use

Certification

Internal quality improvement

Professional certification

Measurement Setting

Ambulatory/Office-based Care

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 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

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Encounter

Patient/Individual (Consumer) Characteristic

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
The number of myelodysplastic syndromes (MDS) patients in your selection who are higher-risk (intermediate-2, or high-risk using International Prognostic Scoring System [IPSS], very high-risk using IPSS-R, and/or with excess blasts, or high- or very high-risk using World Health Organization-based Prognostic Scoring System [WPSS])

Patients can be included in the chart abstraction if:

  • They have been seen by the practice within the past 18 months
  • Management decisions regarding care are made primarily by providers in the practice
  • They are greater than 18 years old (or the age at which your institution refers to adult hematologists)

Note: Refer to the original measure documentation for a list of International Classification of Diseases, Tenth Revision (ICD-10) codes used in MDS patient selection.

Exclusions

  • Patient with successful hematopoietic stem cell transplant
  • Patient refused treatment

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
The number of myelodysplastic syndromes (MDS) patients in your selection who are

  • Higher-risk (intermediate-2, or high-risk using International Prognostic Scoring System [IPSS], very high-risk using IPSS-R, and/or with excess blasts, or high- or very high-risk using World Health Organization-Based Prognostic Scoring System [WPSS])

    AND

  • Receiving azacitidine or decitabine

Note: Receiving azacitidine or decitabine means you prescribed or confirmed that the patient was prescribed azacitidine or decitabine. Refer to the original measure documentation for a list of International Classification of Diseases, Tenth Revision (ICD-10) codes used in MDS patient selection and a list of Healthcare Common Procedure Coding System (HCPCS) codes for azacitidine or decitabine.

Exclusions

  • Patient with successful hematopoietic stem cell transplant
  • Patient refused treatment

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

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure 5: Higher-risk (intermediate-2, or high-risk using IPSS, very high-risk using IPSS-R, and/or with excess blasts, or high- or very high-risk using WPSS) MDS patient receiving azacitidine or decitabine.

Measure Collection Name

Myelodysplastic Syndromes Measure Set

Submitter

American Society of Hematology - Medical Specialty Society

Developer

American Society of Hematology - Medical Specialty Society

Funding Source(s)

The American Society of Hematology

Composition of the Group that Developed the Measure

The American Society of Hematology (ASH) Myelodysplastic Syndromes (MDS) Task Force:

  • Lawrence A. Solberg, Jr., MD, PhD (Chair)
  • Mikkael Sekeres, MD, MS
  • Timothy Miley, MD
  • Kenneth R. Adler, MD
  • Steven Allen, MD
  • David P. Steensma, Jr., MD, PhD
  • Karen Kayoumi (ASH)
  • Charles Clayton (ASH)
  • Suzanne Leous (ASH)
  • Sue Frechette, RN, MBA (Northfield Associates LLC)
  • Debra Reis (Healthmonix)
  • Lauren Patrick (Healthmonix)

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2017 Feb

Measure Maintenance

American Society of Hematology (ASH) reviews/updates measures annually

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

This measure updates a previous version: American Society of Hematology (ASH). Myelodysplastic syndromes (MDS) measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2015 Dec. 16 p.

Source(s)

American Society of Hematology (ASH). Myelodysplastic syndromes (MDS) measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 14 p.

Measure Availability

Source not available electronically.

For more information, contact the American Society of Hematology (ASH) at 2021 L Street NW, Suite 900, Washington, DC 20036; Phone: 202-776-0544; Fax: 202-776-0545; Web site: www.hematology.org External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on July 20, 2015. The information was verified by the measure developer on August 27, 2015.

This NQMC summary was updated by ECRI Institute on April 18, 2016. The information was verified by the measure developer on May 24, 2016.

This NQMC summary was updated again by ECRI Institute on March 21, 2017. The information was verified by the measure developer on May 3, 2017.

Copyright Statement

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

For more information, contact Robert M. Plovnick, MD, MS, Director of Quality Improvement Programs at American Society of Hematology 2021 L Street NW, Suite 900 Washington, DC 20036.

NQMC Disclaimer

The National Quality Measures Clearinghouse™ (NQMC) does not develop, produce, approve, or endorse the measures represented on this site.

All measures summarized by NQMC and hosted on our site are produced under the auspices of medical specialty societies, relevant professional associations, public and private organizations, other government agencies, health care organizations or plans, individuals, and similar entities.

Measures represented on the NQMC Web site are submitted by measure developers, and are screened solely to determine that they meet the NQMC Inclusion Criteria.

NQMC, AHRQ, and its contractor ECRI Institute make no warranties concerning the content or its reliability and/or validity of the quality measures and related materials represented on this site. Moreover, the views and opinions of developers or authors of measures represented on this site do not necessarily state or reflect those of NQMC, AHRQ, or its contractor, ECRI Institute, and inclusion or hosting of measures in NQMC may not be used for advertising or commercial endorsement purposes.

Readers with questions regarding measure content are directed to contact the measure developer.

About NQMC Measure Summaries

NQMC provides structured summaries containing information about measures and their development.

Measure Summary FAQs


Measure Summaries

New This Week

View more and sign up for our Newsletter

Get Adobe Reader