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  • Measure Summary
  • NQMC:011013
  • Feb 2017

Non-Hodgkin lymphoma: percent of lymphoma patients assigned a specific stage using Ann Arbor system including presence/absence of B symptoms AND having bone marrow biopsy or documentation why bone marrow biopsy was unnecessary or contraindicated.

American Society of Hematology (ASH). Non-Hodgkin lymphoma measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 36 p.

This is the current release of the measure.

This measure updates a previous version: American Society of Hematology (ASH). Non-Hodgkin lymphoma measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2015 Dec. 36 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 percent of lymphoma patients assigned a specific stage using Ann Arbor system including presence/absence of B symptoms AND having bone marrow biopsy or documentation why bone marrow biopsy was unnecessary or contraindicated.

Rationale

Support from American Society of Hematology (ASH) Lymphoma Task Force:
Appropriate staging is critical to improving quality of cancer care. Staging systems specific to types of cancer improve the appropriate use of diagnostic testing and are used to plan treatment. Most lymphoma prognostic indices that also guide treatment planning include stage as a key component. Staging is also used to identify clinical trials and improve the ability to compare research results. The National Comprehensive Cancer Network (NCCN) guidelines for diagnosis and treatment of lymphomas are based on staging systems. As such, we believe appropriate staging is essential for planning treatment.

Bone marrow biopsy with or without aspirate is essential in all cases where treatment is considered (NCCN, 2015).

Evidence for Rationale

American Society of Hematology (ASH). Non-Hodgkin lymphoma measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 36 p.

National Comprehensive Cancer Network (NCCN). NCCN clinical practice guidelines in oncology: non-Hodgkin's lymphoma. Version 12.2016. Fort Washington (PA): National Comprehensive Cancer Network (NCCN); 2015 Nov 24.

Primary Health Components

Non-Hodgkin lymphoma (NHL); cancer staging; Ann Arbor system; B symptoms; bone marrow biopsy

Denominator Description

The number of lymphoma patients in your selection (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

The number of lymphoma patients in your selection assigned a specific stage using:

  • Ann Arbor system AND presence/absence of B symptoms

    AND

  • Having bone marrow biopsy OR documentation why a bone marrow biopsy was unnecessary or contraindicated

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

Statement from the research literature on gap:
[In a study] of 472 patients with stage 1 follicular lymphoma (FL) in the National LymphoCare Study (NLCS), incomplete staging occurred in 56% due to lack of bone marrow biopsy (39%), incomplete imaging (4%) or both (13%); this incompletely staged group had more progression events (34% vs. 17%; p less than 0.01) than rigorously staged patients (Friedberg et al., 2011).

Statement from the American Society of Hematology (ASH) Lymphoma Task Force on gap:
This measure has been in use for the American Board of Internal Medicine (ABIM) Maintenance of Certification Performance Improvement Module since July 2013. Performance over the first 10 months (through May 2014) among this highly select group of hematologists is 77%. We believe performance among all hematologists would be somewhat lower. Since accurate diagnosis and staging are the foundation for all treatment, we suggest this gap remains significant.

Evidence for Additional Information Supporting Need for the Measure

American Society of Hematology (ASH). Non-Hodgkin lymphoma measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 36 p.

Friedberg J, Byrtek M, Link B, et al. Should radiation therapy be the standard therapeutic approach for stage 1 follicular lymphoma? A comparative effectiveness analysis of the National LymphoCare Study (NLCS). Ann Oncol. 2011;22(Suppl 4):IV90.

Extent of Measure Testing

The non-Hodgkin lymphoma (NHL) 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 NHL 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 2013.

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

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

Living with Illness

IOM Domain

Effectiveness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
The number of lymphoma patients in your selection

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

Exclusions
None

Exclusions/Exceptions

None

Numerator Inclusions/Exclusions

Inclusions
The number of lymphoma patients in your selection assigned a specific stage using:

  • Ann Arbor system AND presence/absence of B symptoms

    AND

  • Having bone marrow biopsy OR documentation why a bone marrow biopsy was unnecessary or contraindicated

Note: This requires documentation in the patient medical record that includes the Ann Arbor stage including the presence or absence of B symptoms AND having bone marrow biopsy or documenting why a bone marrow biopsy was unnecessary or contraindicated.

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

Desired value is a higher score

Allowance for Patient or Population Factors

Unspecified

Standard of Comparison

Internal time comparison

Original Title

Measure 2: the percent of lymphoma patients assigned a specific stage using Ann Arbor system including presence/absence of B symptoms AND having bone marrow biopsy or documentation why bone marrow biopsy was unnecessary or contraindicated.

Measure Collection Name

Non-Hodgkin Lymphoma 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) Lymphoma Task Force:

  • Joseph Connors, MD (Co-Chair)
  • Jane Winter, MD (Co-Chair)
  • Jonathan Friedberg, MD, MMSc
  • Mikkael Sekeres, MD, MS
  • Lawrence A. Solberg, 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). Non-Hodgkin lymphoma measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2015 Dec. 36 p.

Source(s)

American Society of Hematology (ASH). Non-Hodgkin lymphoma measure set: measure specifications. Washington (DC): American Society of Hematology (ASH); 2017 Feb. 36 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 June 19, 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 the American Society of Hematology (ASH), 2021 L Street NW, Suite 900, Washington, DC 20036.

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