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Table 2 Core measure indicators for colorectal cancer

From: Is quality of colorectal cancer care good enough? Core measures development and its application for comparing hospitals in Taiwan

Indicator Description Numerator Denominator Evidence level or grade of recommendation Rationale
PT1 Proportion of colorectal patients who have pre-operative chest X-ray and abdominal ultrasound, CT scan or MRI18 Number of colorectal patients who have pre-operative chest x-ray and abdominal ultrasound, CT scan or MRI (including off-site) Number of all colorectal patients Grade C Comprehensive-ness of pre-operative evaluation
T1 Proportion of colorectal patients who have undergone surgical resection for colon or rectal cancer have documentation that colonoscopy or barium enema with sigmoidoscopy was offered within 6 months before or after surgery19,20 Number of colorectal patients who have undergone surgical resection for colon or rectal cancer have documentation that colonoscopy or barium enema with sigmoidoscopy (including off-site) was offered within 6 months before or after surgery Number of colorectal patients who have undergone surgical resection for colon or rectal cancer Level II-2 Synchronous colon or rectal cancer
T2* Proportion of colorectal patients who have undergone wide surgical resection for malignant polyp of colon or rectum within 6 weeks of pathological report (polypectomy) revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated19 Proportion of colorectal patients who have undergone wide surgical resection for malignant polyp of colon or rectum within 6 weeks of pathological report (polypectomy) revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated Number of colorectal patients who pathological report for malignant polyp of colon or rectum revealing incomplete or positive margin or venous or lymphatic invasion or poorly undifferentiated Level II-2, III Increase curability
T3a Proportion of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis. (For patient with diagnosis and treatment of care in the same hospital)19,23 Number of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis. (For patient with diagnosis and treatment of care in the same hospital) Number of patients who are diagnosed with colon cancer and do not have metastatic disease. (For patient with diagnosis and treatment of care in the same hospital) Level II-2, III Improve survival
T3b Proportion of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis19,23 Number of patients who are diagnosed with colon cancer and do not have metastatic disease were offered a curative resection within 6 weeks of diagnosis Number of patients who are diagnosed with colon cancer and do not have metastatic disease Level II-2, III Improve
Survival
T4 Proportion of stage I to III colorectal patients who have histopathology reports which give the degree of involvement of surgical margins, including circumferential margins, the number of lymph nodes examined and the number involved21, 22 Number of stage I to III colorectal patients who have histopathology reports which give the degree of involvement of surgical margins, including circumferential margins, the number of lymph nodes examined and the number involved Number of stage I to III colorectal patients excluding patients undergo polypectomy Grade B Provide information for subsequent intervention, which related to tumor recurrence
T5 Proportion of stage I to III colorectal patients who undergo a wide surgical resection that have documented to be "negative margins"19,23 Number of stage I to III colorectal patients who undergo a wide surgical resection that have documented to be "negative margins" Number of stage I to III colorectal patients excluding no pathological report regarding status of margin Level II-2, III Radical excision
T6 Proportion of colorectal patients who undergo a surgery that have a pathology report with the information on tumor size and node differentiation22,24 Number of colorectal patients who undergo a surgery that have a pathology report with the information on tumor size and node differentiation Number of colorectal patients who undergo a surgery Class B Provide information for subsequent intervention and follow-up
T7 Proportion of I to III stage colorectal cancer patients with twelve or more lymph nodes on pathology report25 Number of I to III stage colorectal cancer patients with twelve or more lymph nodes on pathology report Number of I to III stage colorectal cancer patients excluding polypectomy, or neo-radiotherapy Level III or IV Radical excision and pathological accountability
T8* Proportion of pathological report according to CAP checklist or similar one21,26 Number of pathological report according to CAP checklist or similar one Number of colorectal patients   Pathological report comprehensiveness
T9 Proportion of stage III colon cancer patients who was offered chemotherapy within 6 weeks after surgery19,27,28 Number of stage III colon cancer patients who was offered chemotherapy within 6 weeks after surgery Number of stage III colon cancer patients who was offered chemotherapy after surgery (in the same hospital) Level I, II-2, III Increase
Survival
T10 Proportion of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment including surgery, radiotherapy, or CCRT treatment within 6 weeks of diagnosis19,24 Number of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment including surgery, radiotherapy, or CCRT treatment within 6 weeks of diagnosis Number of patients who are diagnosed with Stage II or III rectal cancer, was offered treatment in the same hospital Level II-2, III Avoid treatment delay
T11 Proportion of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered surgical resections within 16 weeks after beginning of CCRT19,23 Number of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered surgical resections within 16 weeks after beginning of CCRT Number of patients who are diagnosed with rectal cancer that appears clinically to be Stage II or III, and was offered CCRT before surgery Level II-2, III Provide treatment for cure intent
F1* Proportion of patients who had completed all courses of therapy for Stage I to III lesions had medical check-up again within 6 months of completion19,29 Number of patients who had completed all courses of therapy for Stage I to III lesions had medical check-up again within 6 months of completion Number of patients who had completed all courses of therapy for Stage I to III lesions Level II-2, III Decrease mortality
F2* Proportion of patients who had completed surgery for Stage I to III lesions had medical check-up again including colonoscopy or LGI series within 2 years period and subsequent 3 years interval19 Number of patients who had completed surgery for Stage I to III lesions had medical check-up again including colonoscopy or LGI series within 2 years period and subsequent 3 years interval Number of patients who had Stage I to III lesions Level II-2, III Decrease recurrence
F3* Proportion of patients who are treated by polypectomy procedure for malignant polyp was offered colonoscopy within 12 months of procedure19,30 Number of patients who are treated by polypectomy procedure for malignant polyp was offered colonoscopy within 12 months of procedure Number of patients who are treated by polypectomy procedure for malignant polyp Level III Decrease recurrence
F4* Five-year over-all survival rate, stage specific (Stage I to IV)28 Number of patients who survive at five-year period, stage specific (Stage I to IV) Number of patients, stage specific (Stage I to IV) Class C Assess survival
F5* Five-year local recurrence rate, stage specific (Stage I to III)18 Number of patients who had recurrence at five-year period, stage specific (Stage I to III) Number of patients, stage specific (Stage I to III) Grade B Assess recurrence
  1. *: indicators excluded in the results due to data un-available.
  2. 1. Stage I to IV are based on classification of TNM system, AJCC (the American Joint Committee on Cancer);
  3. 2. Level I, Level II-2, Level III and Level IV: adopted from RAND19, Desch29; Class B: adopted from SIGN 200322; Class C: adopted from Guideline 200128; Grade B and Grade C: adopted from RCSI 200218; see Additional file 1 for definition.
  4. 3. PT: pre-treatment; T: treatment; F: follow-up; CT: computed tomography; MRI: magnetic resonance imaging; CAP: College of American pathology; CCRT: concurrent chemo-irradiation; LGI series: Lower gastrointestinal series.