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  • Measure Summary
  • NQMC:011016
  • Feb 2017

Non-Hodgkin lymphoma: percent of lymphoma patients of childbearing age who received treatment for lymphoma and who were offered fertility counseling prior to starting treatment OR documentation in the medical record why such counseling was unnecessary.

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 of childbearing age who received treatment for lymphoma and who were offered fertility counseling prior to starting treatment OR documentation in the medical record why such counseling was unnecessary.

Rationale

Support (verbatim) from American Society of Clinical Oncology (ASCO) guidelines:
As part of education and informed consent before cancer therapy, health care providers (including medical oncologists, radiation oncologists, gynecologic oncologists, urologists, hematologists, pediatric oncologists, and surgeons) should address the possibility of infertility with patients treated during their reproductive years (or with parents or guardians of children) and be prepared to discuss fertility preservation options and/or to refer all potential patients to appropriate reproductive specialists. Although patients may be focused initially on their cancer diagnosis, the Update Panel encourages providers to advise patients regarding potential threats to fertility as early as possible in the treatment process so as to allow for the widest array of options for fertility preservation. The discussion should be documented. Sperm and embryo cryopreservation as well as oocyte cryopreservation are considered standard practice and are widely available. Other fertility preservation methods should be considered investigational and should be performed by providers with the necessary expertise (Loren et al., 2013).

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.

Loren AW, Mangu PB, Beck LN, Brennan L, Magdalinski AJ, Partridge AH, Quinn G, Wallace WH, Oktay K, American Society of Clinical Oncology. Fertility preservation for patients with cancer: American Society of Clinical Oncology clinical practice guideline update. J Clin Oncol. 2013 Jul 1;31(19):2500-10. PubMed External Web Site Policy

Primary Health Components

Non-Hodgkin lymphoma (NHL); fertility counseling

Denominator Description

The number of lymphoma patients in your selection:

  • Male AND less than 60 years old

    OR

  • Female AND pre-menopausal

    AND

  • Receiving treatment for lymphoma

See the related "Denominator Inclusions/Exclusions" field.

Numerator Description

The number of lymphoma patients in your selection:

  • Male AND less than 60 years old

    OR

  • Female AND pre-menopausal

    AND

  • Receiving treatment for lymphoma

    AND

  • Received fertility counseling prior to starting treatment

    OR

  • Document in the medical record why such counseling was unnecessary

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

Statements regarding gap:
Less than half of U.S. physicians are following the guidelines from the American Society of Clinical Oncology, which suggest that all patients of childbearing age should be informed about fertility preservation (FP) (Quinn et al., 2009).

Statement from 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 43%. We believe performance among all hematologists would be somewhat lower. This gap, which affects more than half of all patients, even those cared for by a select group of hematologists, 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.

Quinn GP, Vadaparampil ST, Lee JH, Jacobsen PB, Bepler G, Lancaster J, Keefe DL, Albrecht TL. Physician referral for fertility preservation in oncology patients: a national study of practice behaviors. J Clin Oncol. 2009 Dec 10;27(35):5952-7. PubMed External Web Site Policy

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

  • Males less than 60 years of age
  • Pre-menopausal females

Target Population Gender

Either male or female

National Quality Strategy Aim

Better Care

National Quality Strategy Priority

Person- and Family-centered Care
Prevention and Treatment of Leading Causes of Mortality

IOM Care Need

Living with Illness

IOM Domain

Effectiveness

Patient-centeredness

Case Finding Period

Unspecified

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Patient/Individual (Consumer) Characteristic

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
The number of lymphoma patients in your selection:

  • Male AND less than 60 years old

    OR

  • Female AND pre-menopausal

    AND

  • Receiving treatment for lymphoma

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:

  • Male AND less than 60 years old

    OR

  • Female AND pre-menopausal

    AND

  • Receiving treatment for lymphoma

    AND

  • Received fertility counseling prior to starting treatment

    OR

  • Document in the medical record why such counseling was unnecessary

Note: This requires documentation in the patient medical record that fertility counseling was offered to patients of childbearing age prior to starting treatment OR why such counseling was unnecessary.

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 5: the percent of lymphoma patients of child bearing age who received treatment for lymphoma offered fertility counseling prior to starting treatment OR documentation in the medical record why such counseling was unnecessary.

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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