More than 1.7 million Americans will receive a cancer diagnosis this year. Since early detection is the number-one way to increase survival rates for colorectal, breast, and cervical cancer, we continue to seek methods to increase cancer screening rates for at-risk patients.
What is our approach to managing quality for such large populations of patients?
Partners eCare, our electronic health record, allows us to collect health information and develop standardized lists, known as “registries”, to track colorectal cancer screenings (e.g. colonoscopy), breast cancer screenings (e.g. mammography), or cervical cancer screenings (e.g. Pap smear or HPV test) – all in a single location for an entire population of patients. Our population health coordinators work with our clinical team to review the data from these patient registries regularly, so they can reach out to patients to schedule appointments, conduct follow-up preventive services, or otherwise help the care team promote better health.
What are we measuring and why?
Higher screening rates in certain cancers can lead to earlier, less invasive treatment and high survival rates.
How does this measure differ from traditional metrics that rely on claims (billing) data?
We use our electronic health record (EHR) data to identify patients at either normal risk or high risk for colorectal, breast, or cervical cancer, using information such as family history or prior abnormal screening results. Going beyond standard guidelines, we expanded our screening criteria to track and monitor patients who might not fit into the normal measurement criteria but have other indicators that suggest screening as a beneficial and low risk approach to detect early cancer. We then measure appropriate screening rates based on intervals determined by the patient’s risk status. This approach more accurately identifies individuals who should be considered for screening; it also helps clinicians make informed decisions about the appropriateness of screenings for these patients, which can lead to better preventive care and long-term health outcomes.
Breast Cancer
Second only to lung cancer as the leading cause of cancer-related death in U.S. women, breast cancer is highly treatable if caught early—making screenings an important method of preventing breast cancer death. This measure shows the proportion of our eligible patients who were screened for breast cancer using mammography.
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| Total Eligible Patients |
|---|
| Year |
BWPO |
CRMA |
MGPO |
NWPHO |
NSHS |
PHS |
| 2017 |
37,074 |
Not Available* |
40,701 |
26,643 |
Not Available* |
104,418 |
| 2018 |
37,203 |
11,219 |
45,473 |
27,306 |
24,641 |
145,842 |
*2017 data for North Shore Health System and Charles River Medical Associates could not be collected until they upgraded to Partners’ new electronic medical record and had 1 full year of data.
Measure Details
Data Periods: October 2016 - September 2017 and October 2017 - September 2018
Partners HealthCare Data Source: Electronic Health Record (EHR) System
Denominator: Women who are 50-74 years of age or women of any age who have been flagged by the physician using the EHR registry tool as a candidate for breast cancer screening.
Numerator: The number of patients with either 1) a mammogram in the last 2 years or 2) a mammogram in the last year if they are identified in the EHR by the physician as requiring annual mammograms.
Learn more about our measures
Cervical Cancer
A significant cause of morbidity and mortality among women, cervical cancer is treatable if caught early—making cervical cancer screenings an important method of preventing cervical cancer-related death. This measure shows the proportion of our eligible patients who were screened for cervical cancer using Pap smears.
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| Total Eligible Patients |
|---|
| Year |
BWPO |
CRMA |
MGPO |
NWPHO |
NSHS |
PHS |
| 2017 |
68,372 |
Not Available* |
77,595 |
43,901 |
Not Available* |
189,868 |
| 2018 |
66,863 |
16,105 |
85,924 |
44,208 |
38,845 |
251,945 |
*2017 data for North Shore Health System and Charles River Medical Associates could not be collected until they upgraded to Partners’ new electronic medical record and had 1 full year of data.
Measure Details
Data Periods: October 2016 - September 2017 and October 2017 - September 2018
Partners HealthCare Data Source: Electronic Health Record (EHR) System
Denominator:
Women who are 21-64 years of age or women of any age who have been flagged by the physician using the EHR registry tool as a candidate for cervical cancer screening.
Numerator:
The number of patients with either 1) a Pap smear in the last 3 years or 2) a Pap smear in the last 1, 2, or 5 years if they are identified in the EHR by the physician as requiring a modified screening interval based on risk status such as HPV screening results.
Learn more about our measures
Colorectal Cancer
The second-leading cause of cancer-related death in the United States, colorectal cancer is highly treatable if caught early—making screenings an important method of preventing colorectal cancer-related death. This measure shows the proportion of our eligible patients who were screened for colorectal cancer using colonoscopy, flexible sigmoidoscopy, or stool testing.
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| Total Eligible Patients |
|---|
| Year |
BWPO |
CRMA |
MGPO |
NWPHO |
NSHS |
PHS |
| 2017 |
63,384 |
Not Available* |
76,862 |
49,188 |
Not Available* |
189,434 |
| 2018 |
64,767 |
23,242 |
86,825 |
51,358 |
45,949 |
272,141 |
*2017 data for North Shore Health System and Charles River Medical Associates could not be collected until they upgraded to Partners’ new electronic medical record and had 1 full year of data.
Measure Details
Data Periods: October 2016 - September 2017 and October 2017 - September 2018
Partners HealthCare Data Source: Electronic Health Record (EHR) System
Denominator:
Men and women who are 50-74 years of age OR men and women of any age who have been flagged by the physician using the EHR registry tool as a candidate for colorectal cancer screening.
Numerator:
The number of patients with either 1) a colonoscopy or other colorectal cancer screening per the appropriate intervals below or 2) a colonoscopy at the customized frequency identified in the EHR by the physician based on patient risk status such as prior screening results or medical history.
-
Colonoscopy within 10 years, OR
-
Virtual colonography within 5 years, OR
-
Sigmoidoscopy within 5 years with Fecal Immunochemical Testing (FIT) co-testing within 3 years, OR
-
Fecal Occult Blood Testing (FOBT) or FIT(iFOBT) within 1 year, OR
-
DNA FIT within 3 years
Learn more about our measures
Measure Details
We have improved our cancer screening metrics by 1) allowing customization of more aggressive screening age and interval for patients at high risk for these cancers, 2) allowing our physicians to identify those patients who are not candidates for cancer screening, and 3) allowing our physicians to document screening results from outside of our system.
Permanent exceptions allow our clinicians to identify patients for whom cancer screening is no longer clinically appropriate. We count these patients as contributing positively to the numerator. This includes patients with a terminal illness, advanced dementia, or those who have a medical history making them no longer a candidate for recommended screening tests.
Permanent exclusions allow our clinicians to identify patients for whom we are not actively managing their cancer screening program. We remove these patients from the denominator. This includes patients who are deceased or no longer receiving care from our primary care physicians.
