| Valid Data Submission Method(s) | Measure Type | High Priority Measure? | NQS Domain | Specialty Measure Sets |
|---|---|---|---|---|
| Registry | Process | No | Effective Clinical Care | Urology |
Measure Description
Percentage of patients, regardless of age, with a diagnosis of prostate cancer at high or very high risk of recurrence receiving external beam radiotherapy to the prostate who were prescribed adjuvant hormonal therapy (GnRH [gonadotropin-releasing hormone] agonist or antagonist)
Instruction
This measure is to be reported once per episode of radiation therapy for all male patients with prostate cancer who receive external beam radiotherapy to the prostate during the performance period. Each episode of radiation therapy in an eligible patient receiving external beam radiotherapy to the prostate occurring during the performance period will be counted when calculating the data completeness and performance rates. The quality-data code or equivalent needs to be submitted only once during the episode of radiation therapy (e.g., 8 weeks of therapy). It is anticipated that eligible clinicians who perform external beam radiotherapy to the prostate will submit this measure.
Denominator
All patients, regardless of age, with a diagnosis of prostate cancer at high or very high risk of recurrence, receiving external beam radiotherapy to the prostate
Definitions:
Risk Strata – Very Low, Low, Intermediate, High, or Very High–
Very Low Risk – PSA < 10 ng/mL; AND Gleason score 6 or less; AND clinical stage T1c; AND presence of disease in fewer than 3 biopsy cores; AND ≤ 50% prostate cancer involvement in any core; AND PSA density ≤ 0.15 ng/mL/cm3.
Low Risk – PSA < 10 ng/mL; AND Gleason score 6 or less; AND clinical stage T1 to T2a.
Intermediate Risk – PSA 10 to 20 ng/mL; OR Gleason score 7; OR clinical stage T2b to T2c. Note: Patients with multiple adverse factors may be shifted into the high risk category.
High Risk – PSA > 20 ng/mL; OR Gleason score 8 to 10; OR clinically localized stage T3a.
Note: Patients with multiple adverse factors may be shifted into the very high risk category.
Very High Risk – Clinical stage T3b to T4; OR primary Gleason pattern 5; OR more than 4 cores with Gleason score 8 to 10. (NCCN, 2016)
External beam radiotherapy – External beam radiotherapy refers to 3D conformal radiation therapy (3D- CRT), intensity modulated radiation therapy (IMRT), stereotactic body radiotherapy (SBRT), and proton beam therapy.
Denominator Criteria (Eligible Cases):
Any male patient, regardless of age
AND
Diagnosis for prostate cancer (ICD-10-CM): C61
AND
Patient encounter during the performance period (CPT): 77427, 77435
AND
High or very high risk of recurrence of prostate cancer: G8465
AND
NOT DENOMINATOR EXCLUSION:
Diagnosis for metastatic cancer (ICD-10-CM): C77.0, C77.1, C77.2, C77.3, C77.4, C77.5, C77.8, C77.9, C78.00, C78.01, C78.02, C78.1, C78.2, C78.30, C78.39, C78.4, C78.5, C78.6, C78.7, C78.80, C78.89, C79.00, C79.01, C79.02, C79.10, C79.11, C79.19, C79.2, C79.31, C79.32, C79.40, C79.49, C79.51, C79.52, C79.60, C79.61, C79.62, C79.70, C79.71, C79.72, C79.81, C79.82, C79.89, C79.9
Numerator
Patients who were prescribed adjuvant hormonal therapy (GnRH [gonadotropin-releasing hormone] agonist or antagonist)
Definition:
Prescribed – Includes patients who are currently receiving medication(s) that follow the treatment plan recommended at an encounter during the reporting period, even if the prescription for that medication was ordered prior to the encounter.
Numerator Options:
Performance Met: Adjuvant (ie, in combination with external beam radiotherapy to the prostate for prostate cancer) hormonal therapy (gonadotropin-releasing hormone[GnRH] agonist or antagonist) prescribed/administered (4164F)
OR
Denominator Exception: Documentation of medical reason(s) for not prescribing/administering adjuvant hormonal therapy (eg, salvage therapy) (4164F with 1P)
OR
Denominator Exception: Documentation of patient reason(s) for not prescribing/administering adjuvant hormonal therapy (4164F with 2P)
OR
Performance Not Met: Patients who were not prescribed/administered adjuvant hormonal therapy, reason not otherwise specified (4164F with 8P)