Does not apply to this measure

This measure is used to assess the percentage of patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy with documentation of iron stores prior to initiating erythropoietin therapy.

To be effective erythropoietin requires that adequate iron stores be present due to iron's importance in red-blood cell synthesis. Iron deficiency presents a major limitation to the efficacy of erythropoietin therapy.*

*The following clinical recommendation statements are quoted verbatim from the referenced clinical guidelines and represent the evidence base for the measure:

Anemia related to myelodysplastic syndrome (MDS) generally presents as a hypoproductive macrocytic anemia, often associated with suboptimal elevation of serum Epo levels. Iron repletion needs to be verified before instituting Epo therapy. (National Comprehensive Cancer Network [NCCN])

Myelodysplastic syndrome (MDS); erythropoietin therapy; iron stores (bone marrow examination, ferritin, serum iron, total iron binding capacity [TIBC])

All patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy (see the related "Denominator Inclusions/Exclusions" field in the Complete Summary)

Patients with documentation* of iron stores prior to initiating erythropoietin therapy

*Documentation includes either bone marrow examination including iron stain OR serum iron measurement by ferritin or serum iron and total iron binding capacity (TIBC).

• A clinical practice guideline or other peer-reviewed synthesis of the clinical evidence

Unspecified

Current routine use

Internal quality improvement
National reporting

Ambulatory Care
Physician Group Practices/Clinics

Advanced Practice Nurses
Physician Assistants
Physicians

Individual Clinicians

Age greater than or equal to 18 years

Either male or female

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Unspecified

Living with Illness

Effectiveness

Users of care only

All patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy

Patients associated with provider

Inclusions
All patients aged 18 years and older with a diagnosis of myelodysplastic syndrome (MDS) who are receiving erythropoietin therapy*

**Erythropoietin therapy includes the following medications: epoetin and darbepoetin.

Exclusions
Documentation of system reason(s) for not documenting iron stores prior to initiating erythropoietin therapy

All cases in the denominator are equally eligible to appear in the numerator

Clinical Condition
Therapeutic Intervention

Time window is a single point in time

Inclusions
Patients with documentation* of iron stores prior to initiating erythropoietin therapy

*Documentation includes either bone marrow examination including iron stain OR serum iron measurement by ferritin or serum iron and total iron binding capacity (TIBC).

Exclusions
None

The measure results are somewhat or substantially under the control of the health care professionals, organizations and/or policymakers to whom the measure applies.

Episode of care

Administrative data
Medical record

Individual Case

Unspecified

Rate

Better quality is associated with a higher score

Unspecified

Internal time comparison

Unspecified

Measure #2: MDS - documentation of iron stores in patients receiving erythropoietin therapy.

American Medical Association on behalf of the American Society of Hematology and Physician Consortium for Performance Improvement®

American Society of Hematology
Physician Consortium for Performance Improvement®

Unspecified

Steven L. Allen, MD (Co-Chair); William E. Golden, MD (Co-Chair); Kenneth Adler, MD; Daniel Halevy, MD; Stuart Henochowicz, MD, MBA; Timothy Miley, MD; David Morris, MD; John M. Rainey, MD; Samuel M. Silver, MD, PhD; Lawrence Solberg, Jr., MD, PhD

Mila Becker, Esq., American Society of Hematology; Pamela Ferraro, MS, American Society of Hematology; Sue Frechette, BSN, MBA (Consultant), American Society of Hematology

Karen S. Kmetik, PhD, American Medical Association; Samantha Tierney, MPH, American Medical Association

Kristen McNiff, MPH, American Society of Clinical Oncology

Emily Wilson, American Society for Therapeutic Radiology and Oncology

Hildy Dillon, MPH, Leukemia and Lymphoma Society; Mary Grace Pagaduan, MPH, Leukemia and Lymphoma Society

Sue Nedza, MD, MBA, FACEP, Centers for Medicare & Medicaid Services; Sylvia Publ, MBA, RHIA, Centers for Medicare & Medicaid Services

Rebecca Kresowik, Consortium Consultant; Timothy F. Kresowik, MD, Consortium Consultant

Conflicts, if any, are disclosed in accordance with the Physician Consortium for Performance Improvement® conflict of interest policy.

National Quality Forum

Ambulatory Care Quality Alliance
Physician Quality Reporting Initiative

Measure was not adapted from another source.

2007 Jan

This is the current release of the measure.

This NQMC summary was completed by ECRI Institute on September 13, 2007. The information was verified by the measure developer on October 26, 2007.

© Copyright 2006-7 American Medical Association and American Society of Hematology. All Rights Reserved.