Table 4Quality measure ratings - Question 1a

Quality measureQuality measure rating (range 1–5, where 1 = poor and 5 = ideal)Recommendations for the measure
Important and usable (I)Scientifically acceptable (S)Well tested (T)
General measures
Percentage of patients with positive FOBT who underwent an appropriate evaluation4145544Further testing required with reliable data sources.
Time from patient presentation with symptoms to cancer diagnosis46311Additional testing required with larger data set. Measure should be clearly linked to the outcome of interest.
Proportion of colonoscopies that were completed in a timely fashion4754-Additional testing required with larger data set. Measure should be clearly linked to the outcome of interest.
Percentage of patients with colon or rectal cancer undergoing colonoscopy as part of their evaluation48432Measure should be clearly linked to the outcome of interest, such as change in patient management, more accurate staging.
Colonoscopy miss rate for significant colonic neoplasia49,50533No matter how the miss rate is estimated, this is likely not a usable measure because tandem or closely timed colonoscopies are not performed in general clinical practice.
Technical measures
Complication rate of colonoscopy51544Complications to be identified need to be those that are clinically relevant, and precisely defined. The period during which they are identified needs to be accurately specified.
Serious postendoscopic procedure complication rate47,52544Studies have been performed for screening colonoscopies only.
Rate of unplanned reversal of sedation medication4754-Testing required.
Intraprocedure colonoscopy complication rate5354-Testing required.
Colonoscopy completion rate5454-Must explicitly exclude from the numerator and denominator patients who are unable to undergo complete colonoscopy prior to surgery (because of obstruction, need for emergent operation, etc.).
Cecal intubation rate47,52544Testing required. “Cecal intubation” should be appropriately defined including method of cecal identification by landmarks (appendical orifice and ileocecal valve).
Adenoma removal rate for patients over 50 years old4754-Testing required, including validation of the “bench-mark” adenoma rate for different patient populations and establishment of both clinically and statistically relevant deviations from these benchmarks.
Percentage of patients with adequate bowel preparation prior to colonoscopy47,52,55544Additional testing of the measure required. Needs to be linked to a provider- or facility-level process for, e.g., adequate instruction for bowel preparation. Otherwise, this is a measure of patient adherence and not a measure of the quality of care.
Proportion of colonoscopies performed by physicians with specialized training4754-Needs to be developed and further tested on a representative group of physicians. Also, the definition of specialized training needs to be evaluated, specifically is there a threshold number of procedures required?
Percentage of patients with an adequate understanding of the colonoscopy procedure5354-Testing required. The link to an outcome of interest needs to be established (e.g., patient satisfaction, patient compliance with next scheduled procedure).

Note: Investigators used their judgment to determine the quality measure rating for each measure across all studies that utilized the measure. See Appendix F* for details.

From: 3, Results

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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