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Ovarian Measurability v2.5 1

Ovarian Cancer

Measurability of Quality Performance Indicators Version 2.5

To be read in conjunction with:

Ovarian Cancer QPI Final Publication (latest published version)

Epithelial Ovarian Cancer QPI Dataset (latest published version)


Measurability of Quality Performance Indicators for Ovarian Cancer

Please refer to the Ovarian Cancer Quality Performance Indicators published by Healthcare Improvement Scotland for a full description of individual QPIs

Please refer to the Ovarian Cancer QPI Dataset published by ISD Scotland for a full description of individual data items

Document control: This Version

Title Ovarian Cancer Measurability of QPIs Version/Issue Number 2.5

Effective From October 2014 Author Charlotte Anthony, ISD

Document Type Guidance Document status Final

Document Purpose For publication

Summary of changes Amendments to QPIs incorporating amendments to FIGO staging data item and codes; Amendments made out-with review, incorporating additional data items into the dataset updating the MDT QPI.

Revision History

Version Date Status Summary of Changes QPI (s)

0.1 14/1/2013 Draft Version 1 – measurability specification outlined All

0.2 Feb 2013 Draft For public engagement All

0.3 Jul 2013 Draft Updated following comments from public engagement, updates to dataset and QPIs All

0.4 Aug 2013 Draft Updated following comments from Kevin and Iona and updates to dataset All

0.5 Aug 2013 Draft Updated following further clarification from Kevin and updates to dataset

0.6 Sept 2013 Draft Updated following updates to QPIs, dataset and comments from Board review All

0.7 Sept 2013 Draft Updated following Training Day 1,4,5,6,8

1.0 Oct 2013 Final Finalised following public engagement All

1.1 July 2014 Final Amendments to QPIs incorporating amendments to FIGO staging data item and codes; Amendments made out-with review, incorporating additional data items into the dataset updating the MDT QPI.

1,2,5,6,8,9

2.0 Sept 2014 Final Amendments following 9 month review, creating version 2 for use on 1st day 2

nd year of data collection. All

2.1 Mar 2015 Final Amendments to QPI 1 outwith review 1

2.2 May 2015 Final Amendments to QPI 3 outwith review 3

2.3 June 2015 Final Amendments to QPI 4 and 5 outwith review 4 & 5

2.4 July 2015 Final Amendments to QPI 8 outwith review 8

2.5 Mar 2016 Final Amendments following Baseline review 1 & 5

Updates from Previous Version

QPI Summary of changes (excluding formatting changes) (March 2016) (Baseline Review)

1 Denominator inserted the following text ‘and patients who do not undergo ultrasound scan’, ‘AND Risk of Malignancy Index (RMI I) is not coded as inapplicable.’ AND [RMISCORE <>101010]; NR Exclusion inserted following text ‘NB Patients not recorded for RMI are included within the numerator criteria’.

5 Denominator removed ‘or Delayed primary operation – Complete, or Delayed primary operation – Incomplete, and remove SURGTYPE ’OR 4 OR 5’

QPI Summary of changes (excluding formatting changes) (July 2015)

8 Denominator (I) and (II) inserted FIGO stage 4

http://www.healthcareimprovementscotland.org/programmes/cancer_care_improvement/cancer_resources/cancer_qpis.aspx

http://www.isdscotland.org/Health-Topics/Cancer/Cancer-Audit/


QPI Summary of changes (excluding formatting changes) (June 2015)

4 Denominator (ii) Add OR 1c1 OR 1c2 OR 1c3 to FIGO2

5 Numerator (ii) amended to Measurement of Macroscopic Residual Disease coded as None or <1cm - [TUMSIZE = 1 OR 2]

QPI Summary of changes (excluding formatting changes) (May 2015)

3 Add OR [DEFTREATDATE = 10/10/1010] within the Numerator

QPI Summary of changes (excluding formatting changes) (March 2015)

1 Add "OR 4 OR 5" to SURGTYPE within the Denominator

QPI Summary of changes (excluding formatting changes) (September 2014)

1 Removed QPI 1 as inserted in error. Calculations copied into QPI 4

2 Now QPI 1 – removed OR 4 OR 5 from denominator; Removed OR [RMISCORE = 999999] from NR Exclusion.

3 Now QPI 2

4 Now QPI 3 – calculations taken from deleted QPI 1

5 Now QPI 4

6 Now QPI 5

7 Now QPI 6

8 Now QPI 7 – Remove HDIAG from Numerator; Insert [HCONF = 09/09/9999] OR to NR Numerator; Replace HDIAG with HCONF in NR Exclusion and NR Denominator

9 Now QPI 8

10 Now QPI 9

QPI Summary of changes (excluding formatting changes) (July 2014)

1

2 FIGO2 codes replaced with 1a or 1b or 1c or 1c1 or 1c2 or 1c3; ‘Denominator’ removed AND Risk of Malignancy Index (RMI I) coded as anything other than inapplicable, AND [RMISCORE <> 101010]

3

4

5 FIGO2 codes replaced with 1a or 1b or 1c or 1c1 or 1c2 or 1c3

6 FIGO2 codes replaced with 2a or 2b or 2c or 3a or 3a1 or 3a2 or 3b or 3c

7

8 ‘Denominator (i) and (ii) remove Of Epithelial Ovarian Cancer and add Prior to Treatment remove Diagnosis {Cancer} and add Confirmation Prior to Treatment therefore changing HCDIAG to HCCONF, change HDIAG to HCONF

9 FIGO2 codes replaced with 3c or 4a or 4b; Remove [SURGTYPE = 99] from ‘Not recorded exclusion’ and ‘Not recorded for denominator (i)’

10 Removed SACTAGENT2 = 99 from NR Numerator


QPI 1 - Risk of Malignancy Index (RMI I) recorded in the patient notes

QPI Title: Patients with stage 1 epithelial ovarian cancer should have Risk of Malignancy Index (RMI) assessed and recorded in their notes prior to any definitive surgical intervention.

Description:

Proportion of patients with Stage 1 epithelial ovarian cancer having Risk of Malignancy Index (RMI I) assessed and recorded in their notes prior to any definitive surgical intervention.

Numerator: Number of patients with FIGO Stage 1 epithelial ovarian cancer, having Risk of Malignancy Index score recorded in their notes prior to any definitive surgical intervention. Risk of Malignancy Index (RMI I) coded as anything other than not recorded; [RMISCORE <> 999999]

Denominator: All patients with FIGO Stage I epithelial ovarian cancer undergoing definitive surgical intervention. (Excluding Patients presenting for surgery as an emergency, and patients who do not undergo ultrasound scan). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Final FIGO Stage {Ovarian} coded as 1a, 1b, 1c,1c1, 1c2, 1c3; AND Type of Staging Primary Operation {Epithelial Ovarian Cancer} coded as Complete staging operation, Incomplete staging, Incomplete staging – fertility sparing, Delayed Primary Operation – complete, Delayed Primary Operation - incomplete; AND Presentation Type not coded as emergency; AND Risk of Malignancy Index (RMI I) is not coded as inapplicable. [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [FIGO2 = 1a OR 1b OR 1c OR 1c1 OR 1c2 OR 1c3] AND [SURGTYPE = 1 OR 2 OR 3 OR 4 OR 5] AND [PRESENT <> 2] AND [RMISCORE <> 101010]

Not recorded for numerator

Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target N/A - numerator is measuring recorded v’s not recorded therefore patients not recorded for RMISCORE will be included in the numerator not met category

Not recorded for exclusion

Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [PRESENT = 99] NB Patients not recorded for RMI are included within the numerator criteria.

Not recorded for denominator

Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X] OR [FIGO2 = 99] OR [SURGTYPE = 99]


QPI 2 - Extent of disease assessed by Computed Tomography (CT) or Magnetic Resonance Imaging (MRI) prior to treatment

QPI Title:

Patients with epithelial ovarian cancer should have their stage of disease assessed by CT or MRI prior to treatment.

Description:

Proportion of patients with epithelial ovarian cancer having a CT scan or MRI of the abdomen and pelvis performed to exclude the presence of metastatic disease prior to starting definitive treatment.

Numerator: Number of patients with epithelial ovarian cancer having a CT scan or MRI of the abdomen and pelvis carried out prior to starting treatment. Abdomen and Pelvis Imaging Investigations Completed {Epithelial Ovarian Cancer} (Pre-treatment) coded as yes; [SINVEST = 01]

Denominator: All patients with epithelial ovarian cancer. (Excluding Patients who decline to undergo investigation, and patients presenting for surgery as an emergency) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Abdomen and Pelvis Imaging Investigations Completed {Epithelial Ovarian Cancer} (Pre-treatment) not coded as Patient declined investigations and not coded as inapplicable; AND Presentation Type not coded as emergency [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [SINVEST <> (95 OR 96) ] AND [PRESENT <> 2]


Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [SINVEST = 99]


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [SINVEST = 99] OR [PRESENT = 99]


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X]


QPI 3 - Treatment planned and reviewed at a multi-disciplinary team meeting

QPI Title: Patients with newly diagnosed Epithelial Ovarian cancer should be discussed by a multi-disciplinary team prior to definitive treatment. Description: Proportion of patients with Epithelial Ovarian cancer who are discussed at MDT meeting before definitive treatment.

Numerator Number of patients with Epithelial Ovarian cancer discussed at the MDT before definitive treatment. Date Discussed by Care Team (MDT) not coded as not applicable; AND Date Discussed by Care Team (MDT) is before or equal to Date of Definitive Treatment OR Date of Definitive Treatment is equal to not applicable. [MDTDATE <> 10/10/1010] AND ([MDTDATE ≤ DEFTREATDATE] OR [DEFTREATDATE = 10/10/1010])

Denominator All patients diagnosed with Epithelial Ovarian cancer (excluding patients who died before first treatment). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND ‘Site of Origin of Primary Tumour’ coded as Ovarian cancer; AND ‘Type of First Cancer Treatment not coded as Patient died before treatment’. [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [FIRSTTREATMODE <> 94]


Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [MDTDATE = 09/09/0909] OR [DEFTREATDATE = 09/09/0909]


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [FIRSTTREATMODE = 99]


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99X]


QPI 4 - Patients with early stage disease have an adequate staging operation QPI Title:

Patients undergoing surgery for early stage epithelial ovarian cancer (FIGO Stage 1) have an adequate staging operation which includes Total Abdominal Hysterectomy (TAH), Bilateral Salpingo-Oophorectomy (BSO), omentectomy and washings.

Description:

Proportion of patients with early stage epithelial ovarian cancer (FIGO Stage 1) undergoing primary surgery for ovarian cancer, having their stage of disease adequately assessed, (TAH, BSO, Omentectomy and washings), to determine suitability for adjuvant therapies.

Numerator (i) and (ii):

Number of early stage (FIGO Stage 1) epithelial ovarian cancer patients having primary surgery involving TAH, BSO, omentectomy and washings. Type of Staging Primary Operation {Epithelial Ovarian Cancer} coded as Complete staging operation. [SURGTYPE = 1]

Denominator (i):

All early stage (FIGO Stage 1) epithelial ovarian cancer patients undergoing primary surgery. (Excluding Patients having fertility conserving surgery, and Patients with RMI <200, and Patients presenting for emergency surgery) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Final FIGO Stage {Ovarian} coded as 1a, 1b, 1c, 1c1, 1c2, 1c3; AND Main Type of Staging Primary Operation {Epithelial Ovarian Cancer} coded as Complete staging operation, or Incomplete staging; AND Risk of Malignancy Index (RMI I) less than 200; AND Presentation Type not coded as emergency [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [FIGO2 = 1a OR 1b OR 1c OR 1c1 OR 1c2 OR 1c3] AND [SURGTYPE = 1 OR 2] AND [RMISCORE ≥ 200] AND [PRESENT <> 2]

Denominator (ii):

All early stage (FIGO Stage 1) epithelial ovarian cancer patients operated on by a specialist gynaecological oncologist. (Excluding Patients

having fertility conserving surgery, and Patients with RMI <200 and Patients presenting for emergency surgery) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Final FIGO Stage {Ovarian} coded as 1a, 1b, 1c; AND Operating Consultant Gynaecologist {Epithelial Ovarian Cancer} coded as a valid GMC number; AND Main Type of Primary Operation {Epithelial Ovarian Cancer} coded as Complete staging operation, Incomplete staging; AND Risk of Malignancy Index (RMI I) less than 200; AND Presentation Type not coded as emergency [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [FIGO2 = 1a OR 1b OR 1c OR 1c1 OR 1c2 OR 1c3] AND [OPSURG1 <> 1010*] AND [SURGTYPE = 1 OR 2] AND [RMISCORE ≥ 200] AND [PRESENT <> 2] *OPSURG1 will be a list of GMC numbers as agreed and prescribed by the regional managed clinical networks



Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target NB: Patients not recorded for SURGTYPE are excluded from the denominator


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. (i) and (ii) [RMISCORE = 999999] OR [PRESENT = 99] NB: Patients not recorded for SURGTYPE are excluded from the denominator


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard (i) [SITE = C99.X] OR [FIGO2 = 99] OR [SURGTYPE = 99] (ii) [SITE = C99.X] OR [FIGO2 = 99] OR [SURGTYPE = 99] OR [OPSURG1 = 9999]


QPI 5 - No macroscopic residual disease following surgery for advanced disease

QPI Title:

Surgery, as first definitive treatment, on patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) should achieve no macroscopic residual disease.

Description:

Proportion of patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) who have < 1cm residual disease and those who have no macroscopic residual disease following surgery.

Numerator (i): Number of patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) with no macroscopic residual disease following surgery. Measurement of Macroscopic Residual Disease coded as No residual disease [TUMSIZE = 1]

Numerator (ii): Number of patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) undergoing surgery with macroscopic residual disease < 1cm. Measurement of Macroscopic Residual Disease coded as None or <1cm [TUMSIZE = 1 OR 2]

Denominator: All patients with advanced epithelial ovarian cancer (FIGO Stage 2 or higher) undergoing surgery. (Excluding Patients with FIGO Stage 4 disease.) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Final FIGO Stage coded as 2a, 2b, 2c, 3a, 3a1, 3a2, 3b, 3c; AND Type of Staging Primary Operation {Epithelial Ovarian Cancer} coded as Complete staging operation, or Incomplete staging, or Incomplete staging – fertility sparing. . [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [FIGO2 = 2a OR 2b OR 2c OR 3a OR 3a1 OR 3a2 OR 3b OR 3c] AND [SURGTYPE = 1 OR 2 OR 3]


Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target (i) and (ii) [TUMSIZE = 99]


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [FIGO2 = 99]


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X] OR [FIGO2 = 99] OR [SURGTYPE = 99]


QPI 6 - Histopathology reports are complete and support clinical decision making

QPI Title: Histopathology reports relating to pelvic clearance surgery for patients with epithelial ovarian cancer contain all necessary information to inform treatment decision making.

Description: Proportion of patients with epithelial ovarian cancer undergoing pelvic clearance surgery having a complete pathology report as defined by the Royal College of Pathologists

8.

Numerator:

Number of patients with epithelial ovarian cancer undergoing definitive cytoreductive surgery who have a complete pathology report that contains all data items as defined by the Royal College of Pathologists

8

Histopathology Report Complete {Epithelial Ovarian Cancer} coded as complete [PATHCOMPL = 1]

Denominator: All patients with epithelial ovarian cancer undergoing definitive cytoreductive surgery. (No exclusions) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Type of Staging Primary Operation {Epithelial Ovarian Cancer} coded as Complete staging operation or Delayed primary operation – complete [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [SURGTYPE = 1 OR 4]


Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [PATHCOMPL = 99]


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. N/A


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X] OR [SURGTYPE = 99]


QPI 7 – Histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy

QPI Title: Patients with epithelial ovarian cancer should have a histo/cytological diagnosis of their cancer prior to starting neo-adjuvant chemotherapy.

Description:

Proportion of patients with epithelial ovarian cancer having a histo/cytological diagnosis prior to starting neo-adjuvant chemotherapy and the proportion of these with histological confirmation obtained by percutaneous image-guided biopsy or laparoscopy.

Specification (i) Numerator (i)

Number of patients having histo/cytological diagnosis of epithelial ovarian cancer recorded prior to starting chemotherapy. Date of Histological/Cytological Diagnosis {Cancer} is before Date Treatment Started Systemic Anti-Cancer Therapy (SACT) (1-2) AND Date of Histological/Cytological Diagnosis {Cancer} is not coded as not recorded AND Date Treatment Started Systemic Anti-Cancer Therapy (SACT) (1-2) is not coded as inapplicable [HCONF < SACTDATE1] AND [HCONF <> (09/09/0909)] AND [SACTDATE1 <> 10/10/1010]

Denominator (i) All patients with epithelial ovarian cancer undergoing neo-adjuvant chemotherapy. (Excluding Patients for whom paracentesis, image-guided biopsy or laparoscopy is considered not suitable.) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Systemic Anti-Cancer Therapy (SACT) (1-2) {Epithelial Ovarian Cancer} coded as neoadjuvant; AND NOT Histocytological/Cytological Confirmation Prior to Treatment not coded as Clinically inappropriate; OR Date of Histological/Cytological Confirmation Prior to Treatment is not coded as inapplicable) [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [SACT1 = 1] AND NOT ( [HCCONF = 98] OR [HCONF = 10/10/1010] )

Specification (ii)

Numerator (ii)

Number of patients who have a diagnosis of epithelial ovarian cancer confirmed by histology prior to starting chemotherapy. Histocytological/Cytological Confirmation Prior to Treatment Coded as Histological [HCCONF = 1]

Denominator (ii) All patients with epithelial ovarian cancer having histo/cytological diagnosis recorded prior to starting neo-adjuvant chemotherapy. (No exclusions) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Date of Histological/Cytological Confirmation Prior to Treatment is before Date Treatment Started Systemic Anti-Cancer Therapy (SACT) (1-2); AND Systemic Anti-Cancer Therapy (SACT) (1-2) {Epithelial Ovarian Cancer} coded as neoadjuvant [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [HCONF < SACTDATE1 ] AND [SACT1 = 1]


Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target


(i) [HCONF = 09/09/9999] OR [SACTDATE1 = 09/09/0909] NB: Patients not recorded for HCONF are included in the numerator not met category for this QPI (ii) [HCCONF = 99]


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. (i) [HCCONF = 99] OR [HCONF = 09/09/009] (ii) N/A


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard (i) [SITE = C99.X] OR [SACT1 = 99] (ii) [SITE = C99.X] OR [SACT1 = 99] OR [HCONF = 09/09/0909] OR [SACTDATE1 = 09/09/0909]


QPI 8 - Delayed primary surgery

QPI Title:

Delayed primary surgery, after neo-adjuvant chemotherapy for advanced epithelial ovarian cancer (FIGO Stage 3c or 4), should achieve optimal cytoreduction (<1cm).

Description: Proportion of patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) having delayed primary surgery following neo-adjuvant chemotherapy and where optimal cytoreduction is achieved.

Specification (i) Numerator (i):

Number of patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery after neo-adjuvant chemotherapy.

Type of Staging Primary Operation {Epithelial Ovarian Cancer} coded as Delayed primary surgery – complete OR Delayed Primary Surgery - incomplete; AND Date of Primary Surgery {Cancer} after Date Treatment Started Systemic Anti-Cancer Therapy (SACT) (1-2) [SURGTYPE = 4 OR 5] AND [DSURG > SACTDATE1]

Denominator (i):

All patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) having neo-adjuvant chemotherapy. (No exclusions.) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Final FIGO Stage coded as 3c, 4a, 4b; AND Systemic Anti-Cancer Therapy (SACT) (1-2) {Epithelial Ovarian Cancer} coded as neoadjuvant; [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [FIGO2 = 3c OR 4 OR 4a OR 4b] AND [SACT1 = 1]

Specification (ii)

Numerator (ii):

Number of patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery

with

residual disease <1cm (confirmed as including no residual disease) Measurement of Macroscopic Residual Disease coded as None or <1cm [TUMSIZE = 1 OR 2]

Denominator (ii):

All patients with advanced epithelial ovarian cancer (FIGO Stage 3c or 4) undergoing delayed primary surgery after neo-adjuvant chemotherapy). (No exclusions) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND Final FIGO Stage {Ovarian} coded as 3c, 4a, 4b; AND Systemic Anti-Cancer Therapy (SACT) (1-2) {Epithelial Ovarian Cancer} coded as neoadjuvant; AND Type of Staging Primary Operation {Epithelial Ovarian Cancer} coded as Delayed primary surgery – complete OR Delayed Primary Surgery - incomplete; AND Date of Primary Surgery {Cancer} after Date Treatment Started Systemic Anti-Cancer Therapy (SACT) (1-2) [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND [FIGO2 = 3c OR 4 OR 4a OR 4b] AND [SACT1 = 1] AND [SURGTYPE = 4 OR 5] AND [DSURG > SACTDATE1]



Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target (i) [SURGTYPE = 99] OR [DSURG = 09/09/0909] OR [SACTDATE1 = 09/09/0909] (ii) [TUMSIZE = 99]


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. (i) N/A (ii) N/A


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard (i) [SITE = C99.X] OR [SACT1 = 99] OR [FIGO2 = 99] (ii) [SITE = C99.X] OR [SACT1 = 99] OR [FIGO2 = 99] OR [SURGTYPE = 99] OR [DSURG = 09/09/0909] OR [SACTDATE1 = 09/09/0909]


QPI 9: First-line Chemotherapy

QPI Title:

Chemotherapy treatment of epithelial ovarian cancer should include a platinum agent.

Description:

Proportion of epithelial ovarian cancer patients who receive platinum-based chemotherapy, either in combination or as a single agent.

Numerator:

Number of epithelial ovarian cancer patients who receive chemotherapy treatment involving either Paclitaxel in combination with a platinum-based compound or Carboplatin only. Systemic Therapy Agent {Epithelial Ovarian Cancer} (1) coded as Pacilitaxel in combination with platinum based compound, or Carboplatin single agent, [SACTAGENT1 = 1 OR 2]

Denominator: All epithelial ovarian cancer patients. (Excluding Patients with low-grade serous disease; Patients with FIGO stage 1a or 1b, low grade (G1) disease; Patients who decline chemotherapy treatment; and Patients with Stage 1a clear cell tumours.) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Site of Origin of Primary Tumour {Epithelial Ovarian Cancer} coded as ovary, Fallopian Tube, Retroperitoneum, Specified parts of peritoneum, Peritoneum, NOS, Overlapping lesion of retroperitoneum and peritoneum; AND NOT Tumour Grade coded as Serous, Low grade; or ( Final FIGO Stage {Ovarian} coded as 1a, 1b where Tumour Grade is coded as Grade I; OR Systemic Anti-Cancer Therapy (SACT) (1-2) {Epithelial Ovarian Cancer} coded as Patient refused SACT treatment; OR Final FIGO Stage {Ovarian} coded as 1a where Morphology of tumour coded as clear cell ) [SITE = C56.9 OR C57.0 OR C48.0 OR C48.1 OR C48.2 OR C48.8] AND NOT( [GRADE = 04] OR ( [FIGO2 = 1a OR 1b] AND [GRADE = 1] ) OR [SACT1 = 95] OR ( [FIGO2 = 1a] AND [MORPHOL = 8310/3 OR 8313/3] ) )


Include in the denominator for measurement against the target. Present as not recorded only if the patient cannot otherwise be identified as having met/not met the target [SACTAGENT1 = 99]


Include in the denominator for measurement against the target unless there is other definitive evidence that the record should be excluded. Present as not recorded only where the record cannot otherwise be definitively identified as an inclusion/exclusion for this standard. [GRADE = 99] OR [FIGO2 = 99] OR [SACT1 = 99]


Exclude from the denominator for measurement against the target. Present as not recorded only where the patient cannot otherwise be definitively identified as an inclusion/exclusion for this standard [SITE = C99.X]

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