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  2. CQM-1361

Unnecessary duplicative conditions in numerator of CMS 141

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    • Resolution: Answered
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      We appreciate the feedback. The PCPI developed the logic to align with how the drug therapy combinations are described in the guideline, found in the ‘Clinical Recommendation Statement’ header field of the HQMF Human Readable. While they may seem unnecessary, if the drug oxaliplatin was not included, other implementers would question why the measure does not include a drug recommended in the clinical recommendation statement. As such, the PCPI decided to include every possible combination in the eCQM logic.

      Guideline as cited in eCQM Clinical Recommendation Statement:
      For stage III patients (T1-4, N1-2, M0), the panel recommends 6 months of adjuvant chemotherapy following primary surgical treatment. The treatment options are: 5-FU/LV/oxaliplatin (mFOLFOX6) as the standard of care (category 1); bolus 5-FU/LV/oxaliplatin (FLOX, category 1); capecitabine/oxaliplatin (CapeOx); or single agent capecitabine (category 2A) or 5-FU/LV (category 2A) in patients felt to be inappropriate for oxaliplatin therapy. (NCCN, 2012)
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      We appreciate the feedback. The PCPI developed the logic to align with how the drug therapy combinations are described in the guideline, found in the ‘Clinical Recommendation Statement’ header field of the HQMF Human Readable. While they may seem unnecessary, if the drug oxaliplatin was not included, other implementers would question why the measure does not include a drug recommended in the clinical recommendation statement. As such, the PCPI decided to include every possible combination in the eCQM logic. Guideline as cited in eCQM Clinical Recommendation Statement: For stage III patients (T1-4, N1-2, M0), the panel recommends 6 months of adjuvant chemotherapy following primary surgical treatment. The treatment options are: 5-FU/LV/oxaliplatin (mFOLFOX6) as the standard of care (category 1); bolus 5-FU/LV/oxaliplatin (FLOX, category 1); capecitabine/oxaliplatin (CapeOx); or single agent capecitabine (category 2A) or 5-FU/LV (category 2A) in patients felt to be inappropriate for oxaliplatin therapy. (NCCN, 2012)
    • CMS141v4/NQF0385

      For this measure (CMS 141 / NQF 0385), I do not understand the reasoning behind including any oxaliplatin conditions.
      In the numerator, there are eight separate OR branches. The first four are:
      – capecitabine administered
      – capecitabine ordered
      – fluorouracil and leucovorin/levo-leucovorin administered
      – fluorouracil and leucovorin/levo-leucovorin ordered
      Then the last four are the same, but with oxaliplatin added. These seem unnecessary to me, since any instance that passes those branches will already be included in the first four branches.

            rtallapragada Ramya Tallapragada (Inactive)
            cendare Daphne Brinkerhoff
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