Title
Cervical cancer screening: percentage of women 21 to 64 years of age who received one or more Pap tests to screen for cervical cancer.
Source(s)
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
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Primary Measure Domain
Clinical Quality Measures: Process
Secondary Measure Domain
Does not apply to this measure
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Description
This measure is used to assess the percentage of women 21 to 64 years of age who received one or more Pap tests during the measurement year or the two years prior to the measurement year.
Note from the National Quality Measures Clearinghouse (NQMC): For this measure, there are both Administrative and Hybrid Specifications. This NQMC measure summary is based on the Administrative Specification. Refer to the original measure documentation for details pertaining to the Hybrid Specification.
Rationale
Cervical cancer can be detected in its early stages by regular screening using a Pap test. A number of organizations, including the American College of Obstetricians and Gynecologists (ACOG), the American Medical Association (AMA) and the American Cancer Society (ACS), recommend Pap testing every one to three years for all women who have been sexually active or who are over 21.
Evidence for Rationale
ACOG Committee on Practice Bulletins. ACOG Practice Bulletin: clinical management guidelines for obstetrician-gynecologists. Number 45, August 2003. Cervical cytology screening (replaces committee opinion 152, March 1995). Obstet Gynecol 2003 Aug;102(2):417-27. PubMed  |
| Hawkes AP, Kronenberger CB, MacKenzie TD, Mardis AL, Palen TE, Schulter WW, Shah SA, Steele AW, Marine WM. Cervical cancer screening: American College of Preventive Medicine practice policy statement. Am J Prev Med 1996 Sep-Oct;12(5):342-4. [22 references] PubMed |
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
| Saslow D, Runowicz CD, Solomon D, Moscicki AB, Smith RA, Eyre HJ, Cohen C. American Cancer Society guideline for the early detection of cervical neoplasia and cancer. CA Cancer J Clin 2002 Nov-Dec;52(6):342-62. [88 references] PubMed |
Primary Health Components
Cervical cancer; screening; Papanicolaou (Pap) smear
Denominator Description
Women 24 to 64 years of age as of December 31 of the measurement year (see the related "Denominator Inclusions/Exclusions" field)
Numerator Description
One or more Pap tests during the measurement year or the two years prior to the measurement year (see the related "Numerator Inclusions/Exclusions" field)
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Evidence Supporting the Measure
Type of Evidence Supporting the Criterion of Quality for the Measure
- A clinical practice guideline or other peer-reviewed synthesis of the clinical research evidence
- A formal consensus procedure, involving experts in relevant clinical, methodological, public health and organizational sciences
- One or more research studies published in a National Library of Medicine (NLM) indexed, peer-reviewed journal
Additional Information Supporting Need for the Measure
- Cervical cancer is nearly 100 percent preventable, yet it is the second most common cancer among women worldwide. In the United States, about 12,000 women are diagnosed with cervical cancer each year, resulting in more than 4,000 deaths.
- For women in whom pre-cancerous lesions were detected through Pap tests, the likelihood of survival is nearly 100 percent with appropriate evaluation, treatment, and follow up.
- In 2008, the prevalence of recent Pap test use was lowest among older women, women with no health insurance and recent immigrants.
- The total cost of treatment for cervical cancer is $300 to $400 million annually.
- Between 60 and 80 percent of women with advanced cervical cancer have not had a Pap test in the past five years.
- All women are at risk for cervical cancer and women with the lowest levels of education tend to have fewer screenings in their lifetime.
- A woman who does not have regular Pap tests significantly increases her chances of developing cervical cancer.
- Cervical cancer incidence and mortality rates have decreased 67 percent over the past three decades. Most of the reduction can be attributed to the Papanicolaou (Pap) test, which detects cervical cancer and precancerous lesions.
Evidence for Additional Information Supporting Need for the Measure
| American Cancer Society. Cancer prevention & early detection facts & figures 2011. [internet]. 2011 [accessed 2011 May 29]. |
| Centers for Disease Control and Prevention. Cervical cancer. [internet]. 2010 [accessed 2011 Jun 10]. |
| Myers E, Huh WK, Wright JD, Smith JS. The current and future role of screening in the era of HPV vaccination. Gynecol Oncol 2008 May;109(2 Suppl):S31-9. [75 references] PubMed |
| National Cervical Cancer Collation. Early detection. [internet]. [accessed 2011 Jun 10]. |
| National Committee for Quality Assurance (NCQA). The state of health care quality 2011. Continuous improvement and the expansion of quality measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. 199 p. |
Extent of Measure Testing
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State of Use of the Measure
State of Use
Current routine use
Current Use
Accreditation
Decision-making by businesses about health plan purchasing
Decision-making by consumers about health plan/provider choice
External oversight/Medicaid
External oversight/State government program
Internal quality improvement
Pay-for-reporting
Public reporting
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Application of the Measure in its Current Use
Measurement Setting
Managed Care Plans
Professionals Involved in Delivery of Health Services
Advanced Practice Nurses
Nurses
Physician Assistants
Physicians
Least Aggregated Level of Services Delivery Addressed
Single Health Care Delivery or Public Health Organizations
Statement of Acceptable Minimum Sample Size
Specified
Target Population Gender
Female (only)
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National Strategy for Quality Improvement in Health Care
National Quality Strategy Aim
Better Care
National Quality Strategy Priority
Health and Well-being of Communities
Prevention and Treatment of Leading Causes of Mortality
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Institute of Medicine (IOM) National Health Care Quality Report Categories
IOM Care Need
Staying Healthy
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Data Collection for the Measure
Case Finding Period
December 31 of the measurement year
Denominator Sampling Frame
Enrollees or beneficiaries
Denominator (Index) Event or Characteristic
Patient/Individual (Consumer) Characteristic
Denominator Time Window
Time window precedes index event
Denominator Inclusions/Exclusions
Inclusions
Women* 24 to 64 years of age as of December 31 of the measurement year
*Women must have been continuously enrolled during the measurement year (Medicaid and commercial) and the two years prior to the measurement year (commercial).
Allowable Gap: No more than one gap in continuous enrollment of up to 45 days during each year of continuous enrollment (commercial). To determine continuous enrollment for a Medicaid beneficiary for whom enrollment is verified monthly, the member may not have more than a 1-month gap in coverage.
Exclusions
Exclude women who had a hysterectomy with no residual cervix. Look as far back as possible in the member's history for evidence of hysterectomy through December 31 of the measurement year. Refer to Table CCS-B in the original measure documentation for codes to identify a hysterectomy. (Optional)
Exclusions/Exceptions
Medical factors addressed
Numerator Inclusions/Exclusions
Inclusions
One or more Pap tests during the measurement year or the two years prior to the measurement year. A woman had a Pap test if a submitted claim/encounter contains any one of the codes listed in Table CCS-A of the original measure documentation to identify cervical cancer screening.
Exclusions
Unspecified
Numerator Search Strategy
Fixed time period or point in time
Data Source
Administrative clinical data
Paper medical record
Type of Health State
Does not apply to this measure
Instruments Used and/or Associated with the Measure
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Computation of the Measure
Measure Specifies Disaggregation
Does not apply to this measure
Interpretation of Score
Desired value is a higher score
Allowance for Patient or Population Factors
Analysis by subgroup (stratification by individual factors, geographic factors, etc.)
Description of Allowance for Patient or Population Factors
This measure requires that separate rates be reported for commercial and Medicaid product lines.
Standard of Comparison
External comparison at a point in, or interval of, time
External comparison of time trends
Internal time comparison
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Original Title
Cervical cancer screening (CCS).
Submitter
National Committee for Quality Assurance - Health Care Accreditation Organization
Developer
National Committee for Quality Assurance - Health Care Accreditation Organization
Composition of the Group that Developed the Measure
National Committee for Quality Assurance's (NCQA's) Measurement Advisory Panels (MAPs) are composed of clinical and research experts with an understanding of quality performance measurement in the particular clinical content areas.
Financial Disclosures/Other Potential Conflicts of Interest
In order to fulfill National Committee for Quality Assurance's (NCQA's) mission and vision of improving health care quality through measurement, transparency and accountability, all participants in NCQA's expert panels are required to disclose potential conflicts of interest prior to their participation. The goal of this Conflict Policy is to ensure that decisions which impact development of NCQA's products and services are made as objectively as possible, without improper bias or influence.
Endorser
National Quality Forum
Measure Initiative(s)
Ambulatory Care Quality Alliance (AQA)
Physician Quality Reporting System
Adaptation
This measure was not adapted from another source.
Date of Most Current Version in NQMC
2011 Jul
Date of Next Anticipated Revision
Measure Status
Please note: This measure has been updated. The National Quality Measures Clearinghouse is working to update this summary.
Source(s)
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 1, narrative. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
| National Committee for Quality Assurance (NCQA). HEDIS 2012: Healthcare Effectiveness Data and Information Set. Vol. 2, technical specifications for health plans. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. various p. |
Measure Availability
The individual measure, "Cervical Cancer Screening (CCS)," is published in "HEDIS® 2012. Healthcare Effectiveness Data & Information Set. Vol. 2, Technical Specifications for Health Plans."
For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .
Companion Documents
The following is available:
- National Committee for Quality Assurance (NCQA). The state of health care quality 2011. Continuous improvement and the expansion of quality measurement. Washington (DC): National Committee for Quality Assurance (NCQA); 2011. 199 p.
For more information, contact the National Committee for Quality Assurance (NCQA) at 1100 13th Street, NW, Suite 1000, Washington, DC 20005; Telephone: 202-955-3500; Fax: 202-955-3599; Web site: www.ncqa.org .
NQMC Status
This NQMC summary was completed by ECRI on July 18, 2003. The information was verified by the measure developer on October 24, 2003. This NQMC summary was updated by ECRI on June 16, 2006. The information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on November 15, 2007. The information was not verified by the measure developer. This NQMC summary was updated by ECRI Institute on March 6, 2009. The information was verified by the measure developer on May 29, 2009. This NQMC summary was updated by ECRI Institute on January 15, 2010 and again on February 16, 2011. This NQMC summary was retrofitted into the new template on June 29, 2011. This NQMC summary was updated again by ECRI Institute on May 8, 2012.
Copyright Statement
This NQMC summary is based on the original measure, which is subject to the measure developer's copyright restrictions.
For detailed specifications regarding the National Committee on Quality Assurance (NCQA) measures, refer to HEDIS Volume 2: Technical Specifications for Health Plans, available from the NCQA Web site at www.ncqa.org .
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