eMeasure Title

Oncology: Medical and Radiation - Pain Intensity Quantified

eMeasure Identifier (Measure Authoring Tool) 157 eMeasure Version number 4.0.000
NQF Number 0384 GUID 9a0330d0-3d9b-11e1-8634-00237d5bf174
Measurement Period January 1, 20XX through December 31, 20XX
Measure Steward American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Measure Developer American Medical Association-convened Physician Consortium for Performance Improvement(R) (AMA-PCPI)
Endorsed By National Quality Forum
Description
Percentage of patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy in which pain intensity is quantified
Copyright
Copyright 2014 American Medical Association. All Rights Reserved.
Disclaimer
Physician Performance Measures (Measures) and related data specifications have been developed by the American Medical Association (AMA) - convened Physician Consortium for Performance Improvement(R) (PCPI[R]). These Measures are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications. The Measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes, eg, use by health care providers in connection with their practices. Commercial use is defined as the sale, license, or distribution of the Measures for commercial gain, or incorporation of the Measures into a product or service that is sold, licensed or distributed for commercial gain. Commercial uses of the Measures require a license agreement between the user and the AMA, (on behalf of the PCPI). Neither the AMA, PCPI nor its members shall be responsible for any use of the Measures. 

THE MEASURES AND SPECIFICATIONS ARE PROVIDED "AS IS" WITHOUT WARRANTY OF ANY KIND. 

Limited proprietary coding is contained in the Measure specifications for convenience. Users of the proprietary code sets should obtain all necessary licenses from the owners of these code sets. The AMA, the PCPI and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT[R]) or other coding contained in the specifications. 

CPT(R) contained in the Measure specifications is copyright 2004-2014 American Medical Association. LOINC(R) copyright 2004-2014 Regenstrief Institute, Inc. This material contains SNOMED Clinical Terms(R) (SNOMED CT[R]) copyright 2004-2014 International Health Terminology Standards Development Organisation. ICD-10 copyright 2014 World Health Organization. All Rights Reserved.

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Measure Scoring Proportion
Measure Type Process
Measure Item Count
Encounter, Performed: Office Visit
Measure Item Count
Encounter, Performed: Face-to-Face Interaction
Measure Item Count
Procedure, Performed: Radiation Treatment Management
Stratification
None
Risk Adjustment
None
Rate Aggregation
None
Rationale
Inadequate cancer pain management is widely prevalent, harmful to the patient and costly.
Clinical Recommendation Statement
This algorithm begins with the premise that all patients with cancer should be screened for pain during the initial evaluation, follow-up intervals, and whenever new therapy is initiated. If pain is present on a screening evaluation, the pain intensity must be quantified by the patient (whenever possible). Since pain is inherently subjective, patients' self-reporting of pain is the current standard of care for assessment. (NCCN, 2014)

Intensity of pain should be quantified using a numerical rating scale (ie, 0-10), visual analog scale, categorical scale, or pictorial scale (eg, The Faces Pain Rating Scale). Although pain is commonly assessed using numerical or categorical ratings, some patients may experience difficulty with these scales. The Faces Pain Rating Scale may be successful with patients who have difficulty with other scales, for example, children, the elderly, and patients with language or cultural differences or other communication barriers. (NCCN, 2014)

All patients should be routinely screened for pain, and when it is present, pain intensity should be recorded in highly visible ways that facilitate regular review by health care providers. A standard for pain assessment and documentation should be established in each setting to ensure that pain is recognized, documented, and treated promptly. (APS, 2005)
Improvement Notation
Higher score indicates better quality
Reference
National Comprehensive Cancer Network (NCCN). Clinical Practice Guidelines in Oncology: Adult Cancer Pain. Version 2.2014. Available at: http://www.nccn.org.
Reference
Gordon DB; Dahl JL, Miaskowski C, et al. American Pain Society Recommendations for Improving the Quality of Acute and Cancer Pain Management: American Pain Society Quality of Care Task Force. Arch Intern Med. 2005;165:1574-1580.
Definition
None
Guidance
This measure is an episode-of-care measure; the level of analysis for this measure is every visit for patients with a diagnosis of cancer who are also receiving chemotherapy or radiation therapy during the measurement period. For patients receiving radiation therapy, pain intensity should be quantified at each radiation treatment management encounter. For patients receiving chemotherapy, pain intensity should be quantified at each face-to-face encounter with the physician while the patient is receiving treatment. For purposes of calculating this measure, eligible encounters for patients receiving chemotherapy will include those encounters where the patient has been administered chemotherapy within 30 days prior to the encounter and also been administered chemotherapy within 30 days after the date of the encounter. For example, at every visit for patients with a diagnosis of cancer who are also receiving chemotherapy or radiation therapy, the patient should have pain intensity quantified.

Pain intensity should be quantified using a standard instrument, such as a 0-10 numeric rating scale, visual analog scale, a categorical scale, or the pictorial scale.
Transmission Format
TBD
Initial Population
All patient visits, regardless of patient age, with a diagnosis of cancer currently receiving chemotherapy or radiation therapy
Denominator
Equals Initial Population
Denominator Exclusions
None
Numerator
Patient visits in which pain intensity is quantified
Numerator Exclusions
Not Applicable
Denominator Exceptions
None
Measure Population
Not Applicable
Measure Population Exclusions
Not Applicable
Measure Observations
Not Applicable
Supplemental Data Elements
For every patient evaluated by this measure also identify payer, race, ethnicity and sex.

Table of Contents


Population Criteria

Data Criteria (QDM Variables)

Data Criteria (QDM Data Elements)

Supplemental Data Elements

Risk Adjustment Variables


Measure Set
None