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:010979
  • Apr 2008

Pulmonary resection: percentage of patients with lung cancer undergoing pulmonary resection who have documentation of at least one of the specified mediastinal staging procedures.

Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C. Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg. 2008 Sep;86(3):927-32. [40 references] PubMed External Web Site Policy

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Measure Hierarchy

Patient-Centered Quality Indicators for Pulmonary Resection

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 with lung cancer undergoing pulmonary resection who have documentation of at least one of the following mediastinal staging procedures:

  • Cervical mediastinoscopy
  • Positron emission tomography
  • Mediastinal lymphadenectomy

Rationale

More than 30,000 patients undergo pulmonary resection (not including diagnostic lung biopsies) each year in the United States (Memtsoudis et al., 2006). Despite this large number of surgical procedures, there remain to date no standard criteria to measure the quality of care received by patients undergoing pulmonary resection. The general thoracic surgical team developed an a priori set of patient-centered quality of care measures, specific to patients undergoing pulmonary resection.

When treating lung cancer, the most important factor in determining prognosis and treatment options is stage. Mediastinal staging is an essential component of this process. In a recent survey of general thoracic surgery practice, Little and colleagues (2005) reported that cervical mediastinoscopy was performed in only 27.1% of patients with lung cancer. Strikingly, of these patients undergoing mediastinoscopy, 53.4% had no lymph nodes biopsied (Little et al., 2005). Currently, there is debate as to the most effective standard for staging the mediastinum in patients with lung cancer (Meyers et al., 2006). It is clear, nevertheless, that mediastinal staging should be performed as part of a complete evaluation and treatment of patients with lung cancer. At a minimum, at least one or a combination of cervical mediastinoscopy, positron emission tomography, and mediastinal lymphadenectomy should be employed.

Evidence for Rationale

Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C. Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg. 2008 Sep;86(3):927-32. [40 references] PubMed External Web Site Policy

Little AG, Rusch VW, Bonner JA, Gaspar LE, Green MR, Webb WR, Stewart AK. Patterns of surgical care of lung cancer patients. Ann Thorac Surg. 2005 Dec;80(6):2051-6; discussion 2056. PubMed External Web Site Policy

Memtsoudis SG, Besculides MC, Zellos L, Patil N, Rogers SO. Trends in lung surgery: United States 1988 to 2002. Chest. 2006 Nov;130(5):1462-70. PubMed External Web Site Policy

Meyers BF, Haddad F, Siegel BA, Zoole JB, Battafarano RJ, Veeramachaneni N, Cooper JD, Patterson GA. Cost-effectiveness of routine mediastinoscopy in computed tomography- and positron emission tomography-screened patients with stage I lung cancer. J Thorac Cardiovasc Surg. 2006 Apr;131(4):822-9; discussion 822-9. PubMed External Web Site Policy

Primary Health Components

Lung cancer; pulmonary resection; mediastinal staging; cervical mediastinoscopy; positron emission tomography; mediastinal lymphadenectomy

Denominator Description

All patients with lung cancer undergoing pulmonary resection (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Documentation of at least one of the following mediastinal staging procedures:

  • Cervical mediastinoscopy
  • Positron emission tomography
  • Mediastinal lymphadenectomy
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

Unspecified

Extent of Measure Testing

Unspecified

State of Use

Current routine use

Current Use

Internal quality improvement

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

Advanced Practice Nurses

Nurses

Physician Assistants

Physicians

Least Aggregated Level of Services Delivery Addressed

Single Health Care Delivery or Public Health Organizations

Statement of Acceptable Minimum Sample Size

Unspecified

Target Population Age

All ages

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

January to December

Denominator Sampling Frame

Patients associated with provider

Denominator (Index) Event or Characteristic

Clinical Condition

Diagnostic Evaluation

Therapeutic Intervention

Denominator Time Window

Does not apply to this measure

Denominator Inclusions/Exclusions

Inclusions
All patients with lung cancer undergoing pulmonary resection

This includes all patients undergoing pneumonectomy, lobectomy, segmentectomy, sleeve resection, and wedge resection, as well as thoracoscopic or open lung biopsy.

Exclusions
Unspecified

Exclusions/Exceptions

Unspecified

Numerator Inclusions/Exclusions

Inclusions
Documentation of at least one of the following mediastinal staging procedures:

  • Cervical mediastinoscopy
  • Positron emission tomography
  • Mediastinal lymphadenectomy

Note: Mediastinal staging is considered to meet the necessary criteria when at least one of three staging modalities has been performed: cervical mediastinoscopy with lymph node biopsy, positron emission tomography, or intraoperative mediastinal lymphadenectomy. This is measured only in patients with a diagnosis of primary lung cancer.

Exclusions
Unspecified

Numerator Search Strategy

Institutionalization

Data Source

Electronic health/medical record

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

Mediastinal staging.

Measure Collection Name

Patient-Centered Quality Indicators for Pulmonary Resection

Submitter

Division of General Thoracic Surgery, Mayo Clinic - Nonprofit Research Organization

Developer

Division of General Thoracic Surgery, Mayo Clinic - Nonprofit Research Organization

Funding Source(s)

Unspecified

Composition of the Group that Developed the Measure

Stephen D. Cassivi, MD, MS; Mark S. Allen, MD; Gregg D. Vanderwaerdt, MPA; Lori L. Ewoldt, RN; Mary E. Cordes, RN; Dennis A. Wigle, MD, PhD; Francis C. Nichols, MD; Peter C. Pairolero, MD; Claude Deschamps, MD

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2008 Apr

Measure Maintenance

Unspecified

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C. Patient-centered quality indicators for pulmonary resection. Ann Thorac Surg. 2008 Sep;86(3):927-32. [40 references] PubMed External Web Site Policy

Measure Availability

Source available from the Annals of Thoracic Surgery Web site External Web Site Policy.

For more information, contact Dr. Stephen Cassivi at the Mayo Clinic, 200 First St. SW, Rochester, MN, 55905; E-mail: cassivi.stephen@mayo.edu.

NQMC Status

This NQMC summary was completed by ECRI Institute on January 10, 2017. The information was not verified by the measure developer.

Copyright Statement

Reprinted from The Annals of Thoracic Surgery, Vol. 86, Issue 3, Cassivi SD, Allen MS, Vanderwaerdt GD, Ewoldt LL, Cordes ME, Wigle DA, Nichols FC, Pairolero PC, Deschamps C, Patient-centered quality indicators for pulmonary resection, 927-33, Copyright (2008), with permission from Elsevier.

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