Quality Indicators

Quality Indicators

Quality indicators are important in order to evaluate performance and implement quality improvement changes.  Quality indicators help gauge whether changes actually lead to improvement.

The SGO recognizes the importance of continuous quality improvement in clinical practice.  SGO subject matter experts on ovarian, endometrial and cervical cancers studied current evidence-based research to determine the list of quality indicators below. The SGO Registry will also contain data points directly related to these indicators.

The SGO Policy, Quality and Outcomes Taskforce chose many of these indicators to submit to the Physician Quality Reporting System (PQRS) and nine of those, indicated below, are under consideration by the Measure Applications Partnership (MAP.) Should they be accepted, they will be published in the CY 2017 Proposed Medicare Physician Fee Schedule Rule and be open for comment. The SGO taskforce also chose three indicators below to submit to the National Quality Forum for review.

Ovarian Indicators

1. Operative report with documentation of residual disease for women with invasive ovarian, fallopian tube, or peritoneal cancer (Submitted for NQF consideration May 2016)
2. Complete staging for women with invasive stage I?IIIB ovarian, fallopian tube, or peritoneal cancer who have undergone cytoreduction (Submitted for NQF consideration May 2016)
3. Intraperitoneal chemotherapy offered within 42 days of optimal cytoreduction to women with invasive stage III ovarian, fallopian tube, or peritoneal cancer (Under PQRS consideration)
4. Intraperitoneal chemotherapy administered within 42 days of optimal cytoreduction to women with invasive stage III ovarian, fallopian tube, or peritoneal cancer (May be submitted in the future)
5. Platin or taxane administered within 42 days following cytoreduction to women with invasive stage I (grade 3), IC?IV ovarian, fallopian tube, or peritoneal cancer (Under PQRS consideration)
6. VTE prophylaxis administered within 24 hours of cytoreduction to women with invasive ovarian, fallopian tube, or peritoneal cancer (NQF Endorsed #0218)
7. Order for prophylactic parenteral antibiotic administration within 1?2 hours before cytoreduction for women with invasive ovarian, fallopian tube, or peritoneal cancer (NQF Endorsed #0527)
8. Order for prophylactic parenteral antibiotic discontinuation within 24 hours after cytoreduction for women with invasive ovarian, fallopian tube, or peritoneal cancer (NQF Endorsed #0529)

Endometrial Indicators

1. Documentation of residual disease:  Percentage of women ? 18 years of age with stage IV endometrial, cancer undergoing hysterectomy for whom an operative note indicates the amount of residual disease (May be submitted in the future)
2. Minimally invasive surgery discussed and performed for treatment of endometrial carcinoma (Under PQRS consideration; Submitted for NQF consideration May 2016)
3. Chemotherapy and/or radiation therapy offered to patients with stage IIIC/IV endometrial cancer:  Percentage of women ? 18 years of age with stage IIIC/IV endometrial, cancer undergoing primary surgery to remove the uterus for whom there is documentation that chemotherapy and/or radiation therapy was discussed with and offered to the patient (May be submitted in the future)
4. Surgical staging with lymph node removal for any grade 3 and/or myometrial invasion >50% with endometrial cancer (Under PQRS consideration)
5. VTE prophylaxis administered:  Percentage of women ? 18 years of age with endometrial, cancer undergoing surgery to remove the uterus who received Low Molecular Weight Heparin (LMWH), Low-Dose Unfractionated Heparin (LDUH), adjusted-dose warfarin, fondaparinux or mechanical prophylaxis which was given within 24 hours prior to incision time or within 24 hours after surgery end time (NQF endorsed #0218)
6. Timing of Antibiotic prophylaxis:  Percentage of women ? 18 years of age with endometrial, cancer undergoing hysterectomy who have an order for prophylactic parenteral antibiotic to be given within one hour (if fluoroquinolone or vancomycin, two hours), prior to the surgical incision (NQF endorsed #0527)
7. Discontinuation of antibiotics after surgery:  Percentage of women ? 18 years of age with endometrial, cancer undergoing surgery to remove the uterus AND who received a prophylactic parenteral antibiotic, who have an order for discontinuation of prophylactic parenteral antibiotics within 24 hours of surgical end time (NQF endorsed #0529)

Cervical Indicators

1. Use of brachytherapy for patients treated with primary radiation with curative intent (Under PQRS consideration)
2. Completion of external beam radiation within 60 days for women receiving primary radiotherapy as treatment for locally advanced cervical cancer (LACC) (Under PQRS consideration)
3. Use of concurrent platinum-based chemotherapy for patients with stage IIB-IV cervical cancer receiving primary radiation therapy (Under PQRS consideration)
4. Documentation of stage for patients with newly diagnosed cervical cancer; Staging documented prior to initiation of treatment (May be submitted in the future)
5. Performance of radical hysterectomy in patients with IB1-IIA cervical cancer who undergo hysterectomy (Under PQRS consideration)
6. Postoperative pelvic radiation with concurrent cisplatin-containing chemotherapy with (or without) brachytherapy for patients with positive pelvic nodes, positive surgical margin, and/or positive parametrium (Under PQRS consideration)
7. VTE prophylaxis administered within 24 hours of surgery (NQF Endorsed #0218)
8. Order for prophylactic parenteral antibiotic administration within 1?2 hours before surgery (NQF Endorsed #0527)
9. Order for prophylactic parenteral antibiotic discontinuation within 24 hours after surgery (NQF Endorsed #0529)