Lymphoma. Measurability of Quality Performance Indicators Version 2.0

Transcription

1 Lymphoma Measurability of Quality Performance Indicators Version 2.0 To be read in conjunction with: Lymphoma Clinical Quality Performance Indicators (September 2013) Lymphoma Data Definitions V2.0 (September 2014) Lymphoma QPI Measurability V2.0 1

2 Measurability of Quality Performance Indicators for Lymphoma Please refer to the Lymphoma Quality Performance Indicators published by Healthcare Improvement Scotland for a full description of individual QPIs Please refer to the Lymphoma QPI Dataset published by ISD Scotland for a full description of individual data items Document control: This version Title Lymphoma Measurability of QPIs Version/Issue Number 2.0 Effective From 1 st October 2014 Author Jane Garrett Document Type Guidance Document status Final Document Purpose To outline how QPIs should be measured using the agreed National Minimum Core Data Set Summary of changes Amendments made as per agreed outwith review changes, Revision History Version Date Status Summary of Changes QPI (s) V0.1 Mar 2013 Draft First version for public engagement All V0.2 Jun 2013 Draft Updated following public engagement comments and clarification, and updates to QPIs and All dataset V0.3 Aug 2013 Draft Updated following comments from Iona Scott and changes to dataset All V0.4 Sept2013 Draft Updated following changes to dataset All V1.0 Dec 2013 Final For Publication All V1.1 Jun 2014 Final Updated following changes outwith review ALL Updates from Previous Version QPI Summary of changes (excluding formatting changes) 1 2 Numerator change OR s to AND s 3 Numeratoe add AND PETDATE <> 10/10/1010 AND PETREQDATE <> 10/10/ Denominator and NR for Exclusion replace [RADIOTYPE1 <> 94] AND [RSRTDATE1 SACTDATE1] ) OR ( [SACT1 <> 94] AND [SACTDATE1 RSRTDATE1] with [FIRSTTREATTYPE <> 94] 6 Denominator and NR for Denominator - delete SACT2 AND SACT 3; Numerator and NR Numerator delete RCHOP 7 Denominator and NR for Exclusion delete SACT2 AND SACT Numerator and NR for Numerator delete SACTDATE2 and SACTDATE3 and change < to ; Denominator and NR for Denominator - delete RCHOP Lymphoma QPI Measurability V2.0 2

3 QPI 1 Radiological Staging Patients with lymphoma should be evaluated with appropriate imaging to detect the extent of disease and guide treatment decision making. Proportion of patients with lymphoma who undergo Computed Tomography (CT) scanning of the chest, abdomen and pelvis prior to treatment and within 2 weeks of radiology request. Number of patients with lymphoma who undergo CT of chest, abdomen and pelvis prior to treatment and within 2 weeks of radiology request. Radiological Staging Investigations Complete {Lymphoma} coded as Complete CT Chest, Abdomen and Pelvis, or Complete CT Chest, Neck, Abdomen and Pelvis; AND Date Radiological Staging Investigations Completed {Lymphoma} minus Date of Radiology Request is less than or equal to 14 days [SINVEST = 1 OR 2] AND [SINVESTDATE - RADREQDATE 14] All patients with lymphoma (Excluding Patients who refuse investigation, and Patients with primary cutaneous lymphoma) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as Mature B-cell Neoplasms, B-cell Proliferations of Uncertain Malignant Potential, T-Cell and NK-Cell Neoplasms, Nodal, Uncertain if B or T cell, Hodgkin Lymphoma, or Dendritic Cell Neoplasms; AND Radiological Staging Investigations Complete {Lymphoma} not coded as Patient refused investigation [MORPHOL = OR 95913A OR 95913B OR 96713C OR 97613D OR 96993A OR 96993B OR OR OR OR 96983A OR 96983B OR OR 96803A OR 96803B OR 96803D OR 96803E OR 96803F OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR 96633A OR OR OR 96633B OR OR OR 96533A OR 96533B OR 96533C] AND [SINVEST <> 95] 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] OR [RADREQDATE = 09/09/0909] OR [SINVESTDATE = 09/09/0909] not recorded only where the record cannot otherwise be definitively. [SINVEST = 99] NB Patients not recorded for MORPHOL are excluded from the denominator [MORPHOL = 9999/9] Lymphoma QPI Measurability V2.0 3

4 QPI 2 Treatment Response Patients with Diffuse Large B Cell Lymphoma (DLBCL) who are treated with curative intent should have their response to treatment evaluated with appropriate imaging. Proportion of patients with DLBCL who are undergoing chemotherapy treatment with curative intent, who have their response to treatment evaluated with CT scan of the chest, abdomen and pelvis. Number of patients with DLBCL who are undergoing chemotherapy treatment with curative intent who undergo CT of chest, abdomen and pelvis at end of chemotherapy treatment (following 6 or 8 cycles) 1. Date of Radiological Imaging Post Treatment Completed {Lymphoma} - Date Completed Systemici Anti-Cancer Therapy (SACT) {Cancer} less than or equal to 42 days AND Date of Radiological Imaging Post Treatment Completed {Lymphoma} not inapplicable AND Date Completed Systemici Anti- Cancer Therapy (SACT) {Cancer} not inapplicable ; AND Total Number of Systemic Anti-Cancer Therapy Cycles Given (SACT) (1) coded as 6 or 8. ([POSTIMAGDATE - SACTENDATE1 42] AND [POSTIMAGDATE <> 10/10/1010] AND [SACTENDATE1 <> 10/10/1010]) AND ( [SACTCYC1 = 6 OR 8] ) All patients with DLBCL who are undergoing chemotherapy treatment with curative intent (No exclusions). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as DLBCL; AND Type of Systemic Anti-Cancer Therapy (SACT) (1) coded as Chemotherapy, or Chemoimmunotherapy; AND Treatment Intent coded as Curative; [MORPHOL = 96803A OR 96803B OR 96803C OR 96803D OR 96803E OR 96803F OR OR OR OR OR OR OR 96783] AND [SACT1 = 1 OR 2] AND [INTENT = 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 [POSTIMAGDATE = 09/09/0909] OR [SACTENDATE1 = 09/09/0909] OR [SACTCYC1 = 99] not recorded only where the record cannot otherwise be definitively. N/A [MORPHOL = 9999/9] OR [SACT1 = 99] OR [INTENT = 99] 1 Within the measurement of this QPI, CT scans within 6 weeks of the final cycle of chemotherapy will be classified as an end of treatment scan. Lymphoma QPI Measurability V2.0 4

5 QPI 3 Positron Emission Tomography (PET CT) Staging Patients with Classical Hodgkin Lymphoma should be evaluated with PET CT scanning to detect the extent of disease and guide treatment decision making. Proportion of patients with Classical Hodgkin Lymphoma (CHL) who undergo PET CT scan prior to first treatment and within 2 weeks of radiology request. Number of patients with CHL who undergo PET CT prior to treatment and within 2 weeks of radiology request. FDG-PET/CT (PET/CT) Scan {Lymphoma} (Pre-treatment) coded as Yes; AND Date of Integrated FDG-PET/CT (PET/CT) Scan {Lymphoma} (Pretreatment) minus Date of Radiology Request for FDG-PET/CT (PET/CT) Scan {Lymphoma} (Pre-treatment) is less than or equal to 14 days AND Date of Integrated FDG-PET/CT (PET/CT) Scan {Lymphoma} (Pre-treatment) not equal to 10/10/1010 AND Date of Radiology Request for FDG-PET/CT (PET/CT) Scan {Lymphoma} (Pre-treatment) not equal to 10/10/1010 [PETSCAN = 1] AND [PETDATE - PETREQDATE 14] AND PETDATE <> 10/10/10110 AND PETREQDATE <> 10/10/1010 All patients with CHL (Excludes Patients who refuse investigation) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as CHL; AND FDG-PET/CT (PET/CT) Scan {Lymphoma} (Pre-treatment) not coded as Patient refused investigation [MORPHOL = OR 96633A OR 96633B OR 96533A OR 96533B OR 96533C OR OR OR OR 96513] AND [PETSCAN <> 95] 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 [PETSCAN = 99] OR [PETREQDATE = 09/09/0909] OR [PETDATE = 09/09/0909] not recorded only where the record cannot otherwise be definitively. [PETSCAN = 99] [MORPHOL = 9999/9] Lymphoma QPI Measurability V2.0 5

6 QPI 4 Cytogenetic Testing Patients with Burkitt Lymphoma and Diffuse Large B-Cell Lymphoma (DLBCL) should have MYC testing as part of diagnostic process, to identify those who require CNS prophylaxis and alternative treatment. Proportion of patients with Burkitt Lymphoma and DLBCL who have MYC testing as part of diagnostic process and prior to treatment. Number of patients with Burkitt Lymphoma and DLBCL who have MYC testing prior to treatment. Date MYC Testing Reported [DLBCL/Burkitts Lymphoma] not inapplicable; AND before Date Started Systemic Anti-Cancer Therapy (SACT) {Cancer} (1); OR before Date Treatment Started {Cancer} (Radiotherapy) [MYCDATE <> 10/10/1010] AND ( [MYCDATE < SACTDATE1] OR [MYCDATE < RSRTDATE1] ) All patients with Burkitt Lymphoma and DLBCL (No exclusions). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as Burkitt Lymphoma or DLBCL [MORPHOL = OR 96803A OR 96803B OR 96803C OR 96803D OR 96803E OR 96803F OR OR OR OR OR OR OR 96783] 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 [MYCDATE = 09/09/0909] OR [SACTDATE1 = 09/09/0909] OR [RSRTDATE = 09/09/0909] not recorded only where the record cannot otherwise be definitively. N/A [MORPHOL = 9999/9] Lymphoma QPI Measurability V2.0 6

7 QPI 5 Lymphoma MDT Patients with lymphoma should be discussed by a multidisciplinary team at diagnosis. Proportion of patients with lymphoma who are discussed at MDT meeting within 6 weeks of diagnosis. Number of patients with lymphoma discussed at the MDT within 6 weeks of diagnosis. Date Discussed by Haematology Care Team (MDT) is not inapplicable; AND Date Discussed by Care Team (MDT) minus Date of Diagnosis is less than or equal to 42 days (6 weeks) [MDTDATE <> 10/10/1010] AND [MDTDATE DIAGDATE 42] All patients with lymphoma.(excluding Patients who died before first treatment; and Patients with primary cutaneous lymphoma) Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as Mature B-cell Neoplasms, B-cell Proliferations of Uncertain Malignant Potential, T-Cell and NK-Cell Neoplasms, Nodal, Uncertain if B or T cell, Hodgkin Lymphoma, or Dendritic Cell Neoplasms; AND Type of First Treatment <> 94 [MORPHOL = OR 95913A OR 95913B OR 96713C OR 96803A OR 96803B OR 96803D OR 96803E OR 96803F OR 97613D OR 96993A OR 96993B OR OR OR OR 96983A OR 96983B OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR OR 96633A OR OR OR 96633B OR OR OR 96533A OR 96533B OR 96533C] AND [FIRSTTREATTYPE <> 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] NB: Patients not recorded for DIAGDATE are excluded from the denominator not recorded only where the record cannot otherwise be definitively. [FIRSTTREATTYPE = 99] NB: Patients not recorded for MORPHOL are excluded from the denominator for denominator [MORPHOL = 9999/9] Lymphoma QPI Measurability V2.0 7

8 QPI 6 Treatment for Follicular Lymphoma and Diffuse Large B-Cell Lymphoma Patients with symptomatic advanced follicular lymphoma* and Diffuse Large B Cell Lymphoma (DLBCL) should undergo treatment with rituximab in combination with chemotherapy. Proportion of patients with follicular lymphoma and DLBCL undergoing treatment with chemotherapy who receive rituximab. * As it is difficult to accurately identify those patients with symptomatic advanced follicular lymphoma and DLBCL, the number of patients with follicular lymphoma and DLBCL undergoing chemotherapy is being utilised as a proxy measure for symptomatic advanced disease. Number of patients with follicular lymphoma and DLBCL who receive chemotherapy in combination with rituximab. Rituximab {Lymphoma} coded as yes (RITUXIMAB = yes All patients with follicular lymphoma and DLBCL who receive chemotherapy (Excluding Patients who refuse chemotherapy; and Patients enrolled in clinical trials). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as follicular lymphoma or DLBCL; AND Type of Systemic Anti-Cancer Therapy (SACT) coded as Chemotherapy, Chemoimmunotherapy; AND Patient Entered into Clinical Trial {Lymphoma} not coded as Yes [MORPHOL = OR OR OR 96983A OR 96983B OR 96803A OR 96803B OR 96803C OR 96803D OR 96803E OR 96803F OR OR OR OR OR OR OR 96783] AND [SACT1 = 1 OR 2] AND [TRIAL <> 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 [RITUXIMAB = 99 not recorded only where the record cannot otherwise be definitively. [TRIAL = 99] NB Patients not recorded for MORPHOL or SACT1-2 are excluded from the denominator [MORPHOL = 9999/9] OR [SACT1 = 99] Lymphoma QPI Measurability V2.0 8

9 QPI 7 Treatment of Grade 3b Follicular Lymphoma Patients with grade 3b follicular lymphoma should be treated as per Diffuse Large B-cell Lymphoma (DLBCL). Proportion of patients with grade 3b follicular lymphoma who receive treatment with R-CHOP 2. Number of patients with grade 3b follicular lymphoma who receive R-CHOP chemotherapy. R-CHOP codes as yes (RCHOP = yes) All patients with grade 3b follicular lymphoma (Excluding Patients who refuse chemotherapy; and Patients enrolled in clinical trials). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as Grade 3B Follicular Lymphoma; AND Type of Systemic Anti-Cancer Therapy (SACT) not coded as Patient refused SACT treatment; AND Patient Entered into Clinical Trial {Lymphoma} not coded as Yes [MORPHOL = 96983B] AND [SACT1 <> 95] AND [TRIAL <> 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 [RCHOP = 99] not recorded only where the record cannot otherwise be definitively. [SACT1 = 99] OR [TRIAL = 99] [MORPHOL = 9999/9] 2 R-CHOP is a chemotherapy regimen which includes rituximab, cyclophosphamide, doxorubicin, vincristine and prednisilone. Lymphoma QPI Measurability V2.0 9

10 QPI 8 Treatment for Stage 1a Diffuse Large B Cell Lymphoma Patients with stage 1a Diffuse Large B-Cell Lymphoma (DLBCL) should receive combination modality treatment. Proportion of patients with nodal, non-bulky 3 stage 1a DLBCL who receive local radiotherapy, in combination with chemotherapy. Number of patients with nodal, non-bulky stage 1a DLBCL who receive local radiotherapy, in combination with limited chemotherapy (3 cycles). Radiotherapy Course Type {Lymphoma} coded as Yes; AND Type of Systemic Anti-Cancer Therapy (SACT) (1) coded as Chemotherapy; AND Total Number of Systemic Anti-Cancer Therapy Cycles Given (SACT) (1) coded as 3 [RADIOTYPE = 1] AND [SACT1 = 1] AND [SACTCYC1 = 3] All patients with nodal, non-bulky stage 1a DLBCL (Excluding Patients who refuse chemotherapy or radiotherapy treatment; Patients with contraindication to local radiotherapy (e.g. prior radiotherapy or severe connective tissue disease); and Patients enrolled in clinical trials). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as DLBCL; AND Cotswold Clinical Stage {Lymphoma} coded as I; AND B Symptoms {Lymphoma} coded as No; AND Bulk Disease coded as None; AND Radiotherapy Course Type {Lymphoma} not coded as Patient refused treatment OR Type of Systemic Anti-Cancer Therapy (SACT) (1) not coded as Patient refused SACT treatment; AND Radiotherapy Course Type {Lymphoma} not coded as Patient contraindicated in treatment; AND Patient Entered into Clinical Trial {Lymphoma} not coded as Yes [MORPHOL = 96803A OR 96803B OR 96803C OR 96803D OR 96803E OR 96803F OR OR OR OR OR OR OR 96783] AND [COTSWALD = 1] AND [BSYMPTOM = 2] AND [BULKDISEASE = 2] AND [RADIOTYPE1 <> 93] AND ( [RADIOTYPE1 <> 95] OR [SACT1 <> 95] ) AND [TRIAL <> 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 [RADIOTYPE = 99] OR [SACT1 = 99] OR [SACTCYC1 = 9999] not recorded only where the record cannot otherwise be definitively. [RADIOTYPE1 = 99 ] OR [SACT1 = 99] OR [TRIAL 99] [MORPHOL = 9999/9] OR [COTSWALD = 99] OR [BULKDISEASE = 99] OR [BSYMTOM = 99] 3 Non-bulky disease is defined as: nodal masses <10cm, mediastinal masses <0.33, intrathoracic diameter D5/6 Lymphoma QPI Measurability V2.0 10

11 QPI 9 Treatment for Classical Hodgkin Lymphoma Patients with early stage Classical Hodgkin Lymphoma (CHL) should receive combined modality treatment. Proportion of patients with early stage (stage 1a or 2a) CHL who receive combined modality treatment (chemotherapy and radiotherapy). Number of patients with stage 1a or 2a CHL who receive combined modality treatment (chemotherapy and radiotherapy). Radiotherapy Course Type {Lymphoma} coded as Yes; AND Type of Systemic Anti-Cancer Therapy (SACT) (1) coded as Chemotherapy; [RADIOTYPE = 1] AND [SACT1 = 1] All patients with stage 1a or 2a CHL (Excluding Patients who refuse chemotherapy or radiotherapy treatment; Patients with contraindication to local radiotherapy (e.g. prior radiotherapy or severe connective tissue disease); Patients enrolled in clinical trials). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as CHL; AND Cotswold Clinical Stage {Lymphoma} coded as stage 1 or 2; AND B Symptoms {Lymphoma} coded as No; AND Radiotherapy Course Type {Lymphoma} not coded as Patient refused treatment OR Type of Systemic Anti-Cancer Therapy (SACT) (1) not coded as Patient refused SACT treatment; AND Radiotherapy Course Type {Lymphoma} not coded as Patient contraindicated in treatment; AND Patient Entered into Clinical Trial {Lymphoma} not coded as Yes [MORPHOL = OR 96633A OR 96633B OR OR OR OR OR 96533A OR 96533B OR 96533C] AND [COTSWOLD = 1 OR 3] AND [BSYMPTOM = 2] AND [RADIOTYPE1 <> 93] AND ( [RADIOTYPE1 <> 95] OR [SACT1 <> 95] ) AND [TRIAL <> 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 [RADIOTYPE = 99] OR [SACT1 = 99] not recorded only where the record cannot otherwise be definitively. [RADIOTYPE1 = 99 ] OR [SACT1 = 99] OR [TRIAL 99] [MORPHOL = 9999/9] OR [COTSWALD = 99] OR [BSYMTOM = 99] Lymphoma QPI Measurability V2.0 11

12 QPI 10 Primary Cutaneous Lymphoma Patients with primary cutaneous lymphoma should be discussed at a specialist MDT meeting. Proportion of patients with primary cutaneous lymphoma who are discussed at a specialist MDT meeting which includes representation from pathology, dermatology, oncology ± haemato-oncology. Number of patients with primary cutaneous lymphoma who are discussed at a specialist MDT meeting. Date Discussed by Specialist MDT [Primary Cutaneous Lymphoma] is not coded as inapplicable [SPECMDTDATE <> 10/10/1010] All patients with primary cutaneous lymphoma (No exclusions). Date of Diagnosis [DIAGDATE] in range specified for comparative analysis; AND Morphology of Tumour {Lymphoma} coded as Primary Cutaneous Follicle Centre Lymphoma; Primary Cutaneous DLBCL (Leg Type); Primary Cutaneous CD30-positive T-cell Lymphoproliferative Disorders; or Cutaneous T-Cell and NK-Cell Neoplasms [MORPHOL = OR 96803C OR OR OR 97093A OR 97093B OR OR 97013] 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 [SPECMDTDATE = 09/09/0909] not recorded only where the record cannot otherwise be definitively. N/A [MORPHOL = 9999/9] Lymphoma QPI Measurability V2.0 12

13 QPI 11 Hepatitis and HIV Status Virological testing for Human Immunodeficiency Virus (HIV), hepatitis B and C should be undertaken for patients undergoing rituximab treatment. Proportion of patients with lymphoma undergoing rituximab based treatment who have hepatitis B, hepatitis C and HIV status checked prior to treatment. Number of patients with lymphoma undergoing rituximab based treatment who have hepatitis B, C and HIV status checked prior to treatment. Virological Testing (HEPB, HEPC and HIV) coded as Positive; or Negative; AND Date of Virological Testing is less than or equal to Date Started Systemic Anti-Cancer Therapy (SACT) {Cancer} ([HEPB = 1 OR 2] AND [HEPBDATE SACTDATE1]] AND ( [HEPC = 1 OR 2] AND [HEPCDATE SACTDATE1] AND ( [HIV = 1 OR 2] AND [HIVDATE SACTDATE1] All patients with lymphoma undergoing rituximab based treatment (No exclusions). Morphology of Tumour {Lymphoma} coded as Mature B-cell Neoplasms, B-cell Proliferations of Uncertain Malignant Potential, T-Cell and NK-Cell Neoplasms, Primary Cutaneous CD30-positive T-cell Lymphoproliferative Disorders, Nodal, Uncertain if B or T cell, Hodgkin Lymphoma, or Dendritic Cell Neoplasms; AND where rituximab is coded as yes [MORPHOL = OR 95913A OR 95913B OR 96713C OR 97613D OR 96993A OR 96993B OR OR OR OR 96983A OR 96983B OR OR OR 96803A OR OR 96803B OR 96803C OR 96803D OR 96803E OR OR OR OR OR OR OR OR OR 96803F OR OR OR OR OR OR OR OR OR OR OR 97093A OR 97093B OR OR OR OR OR OR OR OR OR OR 96633A OR OR OR 96633B OR OR OR 96533A OR 96533B OR 96533C] AND [RITUXIMAB = yes] 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 [HEPB OR HEPC OR HIV = 99] OR [HEPBDATE OR HEPCDATE OR HIVDATE = 09/09/0909] OR [SACTDATE1 = 09/09/0909] not recorded only where the record cannot otherwise be definitively. NA [MORPHOL = 9999/9] AND [RITUXIMAB = 99] ] Lymphoma QPI Measurability V2.0 13