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  • Measure Summary
  • NQMC:011105
  • Oct 2016

Renal cancer: proportion of patients with T1aN0M0 renal cell carcinoma (RCC) who undergo nephron sparing surgery (NSS) (laparoscopic partial nephrectomy or open partial nephrectomy).

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Renal cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Oct. 33 p. [20 references]

View the original measure documentation External Web Site Policy

This is the current release of the measure.

Primary Measure Domain

Clinical Quality Measures: Process

Secondary Measure Domain

Does not apply to this measure

Description

This measure is used to assess the proportion of patients with T1aN0M0 renal cell carcinoma (RCC) who undergo nephron sparing surgery (NSS) (laparoscopic partial nephrectomy or open partial nephrectomy).

Note from the National Quality Measures Clearinghouse: This measure is part of the Cancer Quality Performance Indicators (QPIs) collection. For more information, including a complete list of QPI measure sets, please visit the Healthcare Improvement Scotland Web site External Web Site Policy.

Rationale

When compared with radical nephrectomy, nephron sparing surgery (NSS) can achieve preserved renal function, decreased overall mortality, reduced frequency of cardiovascular events and increased quality of life for patients. Patients should be informed of these potential advantages of nephron sparing surgery (American Urological Association Education and Research, Inc., 2009).

Surgical resection is the gold standard of care for curative treatment of renal cell carcinoma (RCC). Patients with T1a tumours should undergo NSS where appropriate, as clinical trials have shown that long term survival rates are comparable to those following radical surgery (American Urological Association Education and Research, Inc., 2009; Comprehensive Cancer Centre the Netherlands, 2007; National Institute for Health and Clinical Excellence [NICE], 2002).

Evidence for Rationale

American Urological Association Education and Research, Inc. Guideline for management of the clinical stage 1 renal mass. Linthicum (MD): American Urological Association Education and Research, Inc.; 2009. 81 p. [182 references]

Comprehensive Cancer Centre the Netherlands. Renal cell carcinoma. [internet]. Amsterdam (The Netherlands): Association of Comprehensive Cancer Centres (ACCC); 2007 [accessed 2013 Aug 01].

National Institute for Clinical Excellence (NICE). Improving outcomes in urological cancers. London (UK): National Institute for Clinical Excellence (NICE); 2002 Sep. 141 p. [3 references]

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Renal cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Oct. 33 p. [20 references]

Primary Health Components

T1aN0M0 renal cell carcinoma (RCC); nephron sparing surgery (NSS); laparoscopic partial nephrectomy; open partial nephrectomy

Denominator Description

All patients with T1aN0M0 renal cell carcinoma (RCC) (see the related "Denominator Inclusions/Exclusions" field)

Numerator Description

Number of patients with T1aN0M0 renal cell carcinoma (RCC) undergoing nephron sparing surgery (NSS) (laparoscopic partial nephrectomy or open procedure partial nephrectomy) (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
  • A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences

Additional Information Supporting Need for the Measure

Unspecified

Extent of Measure Testing

The collection of data is piloted on a small number of patient records using a paper data collection form produced by the Information Services Division (ISD). The aim is to identify any anomalies or difficulties with data collection prior to full implementation. At least one NHS board in each Regional Cancer Network participates in the pilot.

Evidence for Extent of Measure Testing

NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p.

State of Use

Current routine use

Current Use

Internal quality improvement

National reporting

Public reporting

Measurement Setting

Hospital Inpatient

Professionals Involved in Delivery of Health Services

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

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

Getting Better

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
All patients with T1aN0M0 renal cell carcinoma (RCC)

Exclusions

  • Patients who refuse treatment
  • Patients who receive radiofrequency ablation (RFA)/cryotherapy
  • Patients receiving supportive care only (not for active treatment)
  • Patients receiving active surveillance (no active treatment)
  • Patients who died before treatment

Exclusions/Exceptions

Medical factors addressed

Patient factors addressed

Numerator Inclusions/Exclusions

Inclusions
Number of patients with T1aN0M0 renal cell carcinoma (RCC) who undergo nephron sparing surgery (NSS) (laparoscopic partial nephrectomy or open procedure partial nephrectomy)

Exclusions

  • Patients who refuse treatment
  • Patients who receive radiofrequency ablation (RFA)/cryotherapy
  • Patients receiving supportive care only (not for active treatment)
  • Patients receiving active surveillance (no active treatment)
  • Patients who died before treatment

Numerator Search Strategy

Fixed time period or point in time

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

External comparison at a point in, or interval of, time

External comparison of time trends

Internal time comparison

Prescriptive standard

Prescriptive Standard

Target: 40%

This target reflects the fact that some patients opt for a laparoscopic radical nephrectomy (LRN) rather than nephron sparing surgery (NSS) due to factors such as shorter convalescence period and decreased complications associated with LRN compared to NSS.

Including this patient group in the exclusion criteria noted above would by default make the target meaningless as 100% would be achieved.

Evidence for Prescriptive Standard

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Renal cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Oct. 33 p. [20 references]

Original Title

QPI 7 – nephron sparing surgery.

Measure Collection Name

Cancer Quality Performance Indicators (QPIs)

Measure Set Name

Renal Cancer

Submitter

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Developer

NHS Scotland - National Government Agency [Non-U.S.]

Scottish Cancer Taskforce - National Government Agency [Non-U.S.]

Funding Source(s)

Scottish Government

Composition of the Group that Developed the Measure

Renal Cancer QPI Development Group

Financial Disclosures/Other Potential Conflicts of Interest

Unspecified

Adaptation

This measure was not adapted from another source.

Date of Most Current Version in NQMC

2016 Oct

Measure Maintenance

The Cancer Quality Performance Indicators (QPIs) will be kept under regular review and be responsive to changes in clinical practice and emerging evidence.

Date of Next Anticipated Revision

Unspecified

Measure Status

This is the current release of the measure.

Source(s)

NHS Scotland, Scottish Cancer Taskforce, National Cancer Quality Steering Group. Renal cancer clinical quality performance indicators. Edinburgh (Scotland): Healthcare Improvement Scotland; 2016 Oct. 33 p. [20 references]

Measure Availability

Source document available from the Healthcare Improvement Scotland Web site External Web Site Policy.

For more information, contact the Healthcare Improvement Scotland at Gyle Square, 1 South Gyle Crescent, Edinburgh, Scotland EH12 9EB; Phone: 0131 623 4300; E-mail: comments.his@nhs.net; Web site: www.healthcareimprovementscotland.org/ External Web Site Policy.

Companion Documents

The following is available:

  • NHS Scotland. National cancer quality performance indicators: overview of development process. Edinburgh (Scotland): NHS Scotland; 2012 Dec. 7 p. This document is available from the Healthcare Improvement Scotland Web site External Web Site Policy.

NQMC Status

This NQMC summary was completed by ECRI Institute on May 16, 2017.

Copyright Statement

No copyright restrictions apply.

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