Evidence Table 3 - Question 1b (Published Literature): What quality-of-care measures are available and what evidence is available for these measures to assess the quality of diagnosis of colorectal cancer, including availability and accuracy of pathologic staging?

StudyCharacteristics of Quality MeasureTesting of Quality MeasureComments/Quality Scoring
Baxter, Virnig, Rothenberger, et al., 2005 Quality measure (QM): Adequate lymph node evaluation Study population: General comments: None
#35800 Basis of QM: Clinical practice guideline (American Joint Committee on Cancer, International Union against Cancer)N: 116,995Rating of quality measure as presented in this study (scale of 1–5, where 1 = poor, 3 = moderate, 5 = ideal):
  • Importance: 5
  • Usability: 5
  • Scientific acceptability (five criteria):
    • Precise specifications: 5
    • Reliability: 3
    • Validity: 3
    • Adaptability: 4
    • Adequacy of risk adjustment: 3
Type of QM: Anatomic site of tumor
(a) ProcessCharacteristicsAll pts (N = 116,995)Right colon (49,613)Left colon (50,536)Rectum (16,846)
(b) GeneralMedian age (yr)71746968
Outcome to which the QM is linked: RecurrenceMales50%44%53%58%
Intent of QM: Not specified (aim of the study was to determine the proportion of colorectal cancer patients in the U.S. who receive adequate lymph node evaluation)Race/ ethnicity
Definition of denominator/numerator: White83%84%82%84%
Denominator:Non-white17%16% 18%16%
Number of patients ≥ 18 yr, diagnosed with localized invasive adenocarcinoma of colon or rectum from Jan 1988-Dec 2001.Tumor stage
Exclusion criteria: Patients with cancer colon not otherwise localized, patients who underwent radical surgical resection, and postoperative radiation.Stage I25%19.50%27%33%
Numerator:Stage II40%45.50%39%29%
Number of above patients with adequate lymph node evaluation (adequate = at least 12 nodes examined)Stage III35%35%34%38%
Data sources: NCI's SEER registryTumor Grade
Recommended frequency of data collection: No recommendationWell or mod diff.82%76%87%83%
Poorly diff.18%24%13%17%
Node No. (Median)91178
Geographic location: U.S.
Dates: Jan 1988-Dec 2001
Healthcare setting: Multiple
Results:
No lymph nodes were examined in 6.5% patients.
Characteristic% of all ptsRates among pts with stage I disease (N = 27,323)Rates among pts with stage II disease (N = 44,771)Rates among pts with stage III disease (N = 38,660)
Overall rates37%25%41%46%
Patient age (yr)
≤ 5051%35%56%57%
51–6040%27%46%48%
61–7036%23%41%45%
≥ 7135%25%37%43%
Year of diagnosis
1988-9033%22%37%40%
1991-335%23%38%44%
1994-636%24%40%45%
1997-940%26%43%49%
2000-143%31%45%52%
Chiaverini, Fulton, and Darcy, 2002 Quality measure (QM): Percentage of newly diagnosed CRC cases that were staged using the AJCC system Study population: General comments: None
#17720 Basis of QM: Clinical practice guideline (implicit that AJCC staging system would follow the American Joint Committee on Cancer guidelines but these are not actually cited in the article. The authors do mention the rules and regulations of the Rhode Island Cancer Registry and the Rhode Island Cancer Control Plan [ref 4]).N: NRRating of quality measure as presented in this study (scale of 1–5, where 1 = poor, 3 = moderate, 5 = ideal):
  • Importance: 4
  • Usability: 4
  • Scientific acceptability (five criteria):
    • Precise specifications: 4
    • Reliability: 3
    • Validity: 3
    • Adaptability: 3
    • Adequacy of risk adjustment: 4
Type of QM: Age: NR
(a) StructureRace: NR
(b) Process and technicalSex: NR
Outcome to which the QM is linked: No outcome linked, but measure is said to be important for choosing appropriate treatmentsTumor stage: NR
Intent of QM: NA (aim of the study was to describe progress in the control of colorectal cancer in Rhode Island, 1987-2000)Performance status: NR
Definition of denominator/numerator: Geographic location: Rhode Island
Denominator:Dates: 1989-2000
Number of Rhode Island men and women newly diagnosed with colorectal cancer in 1989-1999 compared to 2000.Healthcare setting: Multiple
Numerator: Results:
Number of above patients who were staged using the AJCC system.The proportion of cases staged with AJCC staging methodology increased from 65% in 1989 to 92% in 2000 for men, and from 65% in 1989 to 90% in 2000 for women.
Data sources: Rhode Island Cancer Registry
Recommended frequency of data collection: No recommendation
Galvis, Raab, D'Amico, et al., 2001 Quality measure (QM): Lymph node retrieval rate Study population: General comments: None
#20330 Basis of QM: None (but see refs 1–10)N: 176 specimensRating of quality measure as presented in this study (scale of 1–5, where 1 = poor, 3 = moderate, 5 = ideal):
  • Importance: 5
  • Usability: 4
  • Scientific acceptability (five criteria):
    • Precise specifications: 1
    • Reliability: 2
    • Validity: 4
    • Adaptability: 4
    • Adequacy of risk adjustment: 3
Type of QM Geographic location: PA
(a) ProcessDates: Dec 1997-Nov 1999
(b) TechnicalHealthcare setting: University hospital
Outcome to which the QM is linked: Recurrence Results:
Intent of QM: Not specified (aim of the study was to measure the quality of pathologists' assistants' surgical gross examination [vs. that of pathology residents])ExaminerTotal number of casesMean # of lymph nodes
Definition of denominator/numerator: Retrieved per specimenPositive per specimen
Denominator:Pathologist's assistant5031.31.1
Number of colorectal specimens submitted for tumor from Dec 1997-Nov 1999 (all cases for which 5 or more cassettes of tissue were initially submitted for histologic examination).Pathology resident12618.72.2
Numerator:
Number of positive lymph nodes retrieved from above specimens.
Data sources: Retrospective review of surgical pathology reports
Recommended frequency of data collection: No recommendation
Steele, 1994, Quality measure: Percentage of newly diagnosed CRC cases who were staged using the AJCC system Study population: General comments: None
#35840 Basis of QM: Clinical practice guideline (implicit that the AHCC guidelines be followed but these are not actually cited) ColonRectalRating of quality measure as presented in this study (scale of 1–5, where 1 = poor, 3 = moderate, 5 = ideal):
  • Importance: 3
  • Usability: 4
  • Scientific acceptability (five criteria):
    • Precise specifications: 4
    • Reliability: 4
    • Validity: 3
    • Adaptability: 3
    • Adequacy of risk adjustment: 1
Type of QM: 1985-8619911985-861991
(a) Processcases40384397511841817348
(b) TechnicalAge
Outcome to which the QM is linked: No outcome is exactly linked to the above but is said to be a marker of appropriate cancer diagnosis and treatment. No citation is provided for this statement.≤5410.611.213.514.8
Intent of QM: Not specified (aim of the study was to assess cancer patient care and outcomes on a national basis)55–6419.817.223.821.6
Definition of denominator/numerator: 65–7432.321.933.932.9
Denominator:≥7537.339.728.830.7
Number of patients in the National Cancer Data Base (NCDB) with a new diagnosis of colon cancer or rectal cancer (rectosigmoid junction, rectum and anal canal) in the years 1985-1986 or 1991.%male48.749.655.355.7
Numerator:race
Number of the above patients who were staged using the AJCC system.White86.985.988.086.9
Data sources: National Cancer Data Base (NCDB)hispanic1.11.81.62.3
Recommended frequency of data collection: No recommendationAA6.68.14.76.3
Asian0.91.51.22.2
Unk.4.52.74.52.3
Tumor Stage
03.76.55.85.0
114.419.315.218.6
213.826.210.517.4
312.920.312.220.0
49.215.85.07.8
Unk.46.011.951.331.2
Geographic location: National sample; note that the sample is not probabilistic and represented different hospitals in different years
Dates: 1991 and outcomes for 1985-86
Healthcare setting: 464 hospital in 1985, 474 hospitals in 1986, 937 hospitals in 1991
Results: The percent of cases reported as having an “unknown stage” decreased from 46% to 11.9% and 51.3% to 31.2% for colon and rectal cancer cases respectively, between 1985-86 and 1991.

From: Appendix E: Evidence Tables

Cover of Cancer Care Quality Measures
Cancer Care Quality Measures: Diagnosis and Treatment of Colorectal Cancer.
Evidence Reports/Technology Assessments, No. 138.
Patwardhan MB, Samsa GP, McCrory DC, et al.

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