Colorectal Cancer Concepts
0.1.0 - CI Build International flag

Colorectal Cancer Concepts, published by Clinical Quality Framework. This guide is not an authorized publication; it is the continuous build for version 0.1.0 built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/cqframework/cqf-ccc/ and changes regularly. See the Directory of published versions

Measure: Colorectal Cancer Screening CQM (Experimental)

Official URL: http://fhir.org/guides/cqf/ccc/Measure/ColorectalCancerScreeningCQM Version: 0.1.0
Draft as of 2024-05-14 Computable Name: ColorectalCancerScreeningCQM

Copyright/Legal: This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2020 National Committee for Quality Assurance. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 World Health Organization. All Rights Reserved.

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

Illustration

Title: Colorectal Cancer Screening CQM
Id: ColorectalCancerScreeningCQM
Version: 0.1.0
Url: Colorectal Cancer Screening CQM
Effective Period: 2022-01-01 ..2022-12-31
Status: draft
Experimental: true
Date: 2024-05-14 12:25:12-0600
Publisher: Clinical Quality Framework
Description:

Percentage of adults 50-75 years of age who had appropriate screening for colorectal cancer

Jurisdiction: 001
Purpose:

Illustration

Copyright:

This Physician Performance Measure (Measure) and related data specifications are owned and were developed by the National Committee for Quality Assurance (NCQA). NCQA is not responsible for any use of the Measure. NCQA makes no representations, warranties, or endorsement about the quality of any organization or physician that uses or reports performance measures and NCQA has no liability to anyone who relies on such measures or specifications. NCQA holds a copyright in the Measure. The Measure can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by healthcare providers in connection with their practices) without obtaining approval from NCQA. Commercial use is defined as the sale, licensing, or distribution of the Measure for commercial gain, or incorporation of the Measure into a product or service that is sold, licensed or distributed for commercial gain. All commercial uses or requests for modification must be approved by NCQA and are subject to a license at the discretion of NCQA. (C) 2012-2020 National Committee for Quality Assurance. All Rights Reserved.

Limited proprietary coding is contained in the Measure specifications for user convenience. Users of proprietary code sets should obtain all necessary licenses from the owners of the code sets. NCQA disclaims all liability for use or accuracy of any third party codes contained in the specifications.

CPT(R) contained in the Measure specifications is copyright 2004-2020 American Medical Association. LOINC(R) copyright 2004-2020 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2020 International Health Terminology Standards Development Organisation. ICD-10 copyright 2020 World Health Organization. All Rights Reserved.

Disclaimer:

The performance Measure is not a clinical guideline and does not establish a standard of medical care, and has not been tested for all potential applications. THE MEASURE AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND.

Due to technical limitations, registered trademarks are indicated by (R) or [R] and unregistered trademarks are indicated by (TM) or [TM].

Basis: boolean
Scoring:

Proportion

Type:

process

Rationale:

Colorectal cancer represents eight percent of all new cancer cases in the United States. In 2020, there were an estimated 147,950 new cases of colorectal cancer and an estimated 53,200 deaths attributed to it. According to the National Cancer Institute, about 4.2 percent of men and women will be diagnosed with colorectal cancer at some point during their lifetimes. For most adults, older age is the most important risk factor for colorectal cancer, although being male and black are also associated with higher incidence and mortality. Colorectal cancer is most frequently diagnosed among people 65 to 74 years old (National Cancer Institute, 2020).

Screening can be effective for finding precancerous lesions (polyps) that could later become malignant, and for detecting early cancers that can be more easily and effectively treated. Precancerous polyps usually take about 10 to 15 years to develop into colorectal cancer, and most can be found and removed before turning into cancer. The five-year relative survival rate for people whose colorectal cancer is found in the early stage before it has spread is about 90 percent (American Cancer Society, 2020).

Clinical recommendation statement:

The U.S. Preventive Services Task Force (2016) recommends screening for colorectal cancer starting at age 50 years and continuing until age 75 years. This is a Grade A recommendation (U.S. Preventive Services Task Force, 2016). Appropriate screenings are defined by any one of the following: -Colonoscopy (every 10 years) -Flexible sigmoidoscopy (every 5 years) -Fecal occult blood test (annually) -FIT-DNA (every 3 years) -Computed tomographic colonography (every 5 years)

Improvement Notation:

increase

Libraries:
Colorectal Cancer Screening CQM
Related Artifact Dependencies:
  • Colorectal Cancer Elements
  • Colorectal Cancer Concepts
  • http://fhir.org/guides/cqf/ccc/Library/FHIRHelpers|4.0.1
  • http://fhir.org/guides/cqf/ccc/Library/FHIRCommon|4.0.1
  • Fecal Occult Blood Test (FOBT)
  • FIT DNA
  • CT Colonography
  • Flexible Sigmoidoscopy
  • Colonoscopy
  • Parameters:
    name use min max type
    Measurement Period In 0 1 Period
    Numerator Out 0 1 boolean
    Denominator Out 0 1 boolean
    Initial Population Out 0 1 boolean
    DataRequirements:
    Type Elements Valueset Name Valueset
    Observation(Observation) code status value issued Fecal Occult Blood Test (FOBT) Fecal Occult Blood Test (FOBT)
    Observation(Observation) code status value issued FIT DNA FIT DNA
    Procedure(Procedure) code status performed CT Colonography CT Colonography
    Procedure(Procedure) code status performed Flexible Sigmoidoscopy Flexible Sigmoidoscopy
    Procedure(Procedure) code status performed Colonoscopy Colonoscopy
    Patient(Patient)
    Logic Definitions:
    Group Scoring Population Criteria Expression
    Measure scoring:

    Proportion

    Initial Population
    /*
    NOTE: Removed qualifying encounters criteria to simplify for demonstration purposes
    */
    define "Initial Population":
      AgeInYearsAt(start of "Measurement Period") in Interval[50, 75]
    Denominator
    define "Denominator":
      "Initial Population"
    Numerator
    define "Numerator":
      CCE."Has Appropriate Colorectal Cancer Screening"
    Library Name Name
    ColorectalCancerElements Fecal Occult Blood Test Result
    define "Fecal Occult Blood Test Result":
      [Observation: Cx."Fecal Occult Blood Test (FOBT)"] FecalOccultResult
    		where FecalOccultResult.status in {'final', 'amended', 'corrected', 'preliminary'}
    			and FecalOccultResult.value is not null
    Library Name Name
    ColorectalCancerElements AsOf
    define AsOf:
      end of "Measurement Period"
    Library Name Name
    ColorectalCancerElements Fecal Occult Blood Test Result Within 1 Year
    define "Fecal Occult Blood Test Result Within 1 Year":
      "Fecal Occult Blood Test Result" R
        where R.issued 1 year or less on or before AsOf
    Library Name Name
    ColorectalCancerElements Fecal Immunochemical Test DNA Result
    define "Fecal Immunochemical Test DNA Result":
      [Observation: Cx."FIT DNA"] FitDNA
    		where FitDNA.status in {'final', 'amended', 'corrected', 'preliminary'}
    			and FitDNA.value is not null
    Library Name Name
    ColorectalCancerElements Fecal Immunochemical Test DNA Result Within 3 Years
    define "Fecal Immunochemical Test DNA Result Within 3 Years":
      "Fecal Immunochemical Test DNA Result" R
        where R.issued 3 years or less on or before AsOf
    Library Name Name
    ColorectalCancerElements CT Colonography Performed
    define "CT Colonography Performed":
      [Procedure: Cx."CT Colonography"] Colonography
        where Colonography.status = 'completed'
    Library Name Name
    ColorectalCancerElements CT Colonography Performed Within 5 Years
    define "CT Colonography Performed Within 5 Years":
      "CT Colonography Performed" P
        where FC.ToInterval(P.performed) ends 5 years or less on or before AsOf
    Library Name Name
    ColorectalCancerElements Flexible Sigmoidoscopy Performed
    /*
    @description: Completed Flexible Sigmoidoscopy Procedures
    */
    define "Flexible Sigmoidoscopy Performed":
      [Procedure: Cx."Flexible Sigmoidoscopy"] FlexibleSigmoidoscopy
    		where FlexibleSigmoidoscopy.status = 'completed'
    Library Name Name
    ColorectalCancerElements Flexible Sigmoidoscopy Performed Within 5 Years
    define "Flexible Sigmoidoscopy Performed Within 5 Years":
      "Flexible Sigmoidoscopy Performed" P
        where FC.ToInterval(P.performed) ends 5 years or less on or before AsOf
    Library Name Name
    ColorectalCancerElements Colonoscopy Performed
    define "Colonoscopy Performed":
      [Procedure: Cx."Colonoscopy"] Colonoscopy
    		where Colonoscopy.status = 'completed'
    Library Name Name
    ColorectalCancerElements Colonoscopy Performed Within 10 Years
    define "Colonoscopy Performed Within 10 Years":
      "Colonoscopy Performed" P
        where FC.ToInterval(P.performed) ends 10 years or less on or before AsOf
    Library Name Name
    ColorectalCancerElements Has Appropriate Colorectal Cancer Screening
    /*
      FOBT within 1 year
        or FIT DNA within 3 years
        or CT Colonography within 5 years
        or Flexible Sigmoidoscopy within 5 years
        or Colonoscopy within 10 years
    */
    define "Has Appropriate Colorectal Cancer Screening":
      exists "Fecal Occult Blood Test Result Within 1 Year"
        or exists "Fecal Immunochemical Test DNA Result Within 3 Years"
        or exists "CT Colonography Performed Within 5 Years"
        or exists "Flexible Sigmoidoscopy Performed Within 5 Years"
        or exists "Colonoscopy Performed Within 10 Years"
    Library Name Name
    ColorectalCancerScreeningCQM Numerator
    define "Numerator":
      CCE."Has Appropriate Colorectal Cancer Screening"
    Library Name Name
    ColorectalCancerScreeningCQM Initial Population
    /*
    NOTE: Removed qualifying encounters criteria to simplify for demonstration purposes
    */
    define "Initial Population":
      AgeInYearsAt(start of "Measurement Period") in Interval[50, 75]
    Library Name Name
    ColorectalCancerScreeningCQM Denominator
    define "Denominator":
      "Initial Population"