Neuro-Oncology Quality Measurement Set Approved by the AANI and SNO work group on February 9, 2017. Approved by AANI Quality and Safety Subcommitee on February 17, 2017, AANI Practice Committee on March 8, 2017, and AANI Board on March 21,2017. Approved by SNO Guidelines Committee on March 22, 2017 and SNO Board of Directors on April 10, 2017. ©2017. American Academy of Neurology Institute and Society for Neuro-Oncology. All Rights Reserved. CPT® Copyright 2004-2017 American Medical Association. 1 Contents Disclaimer ................................................................................................................................................................................ 3 Work Group Members ............................................................................................................................................................ 4 Improving Outcome for Patients with Neuro-Oncology Conditions ....................................................................................... 5 Rationale for Measures ....................................................................................................................................................... 5 Importance and Prevalence of Neuro-Oncology ................................................................................................................. 5 Common Abbreviations and Definitions for the Measurement Set .................................................................................... 5 2016 Neuro-Oncology Measurement Set ............................................................................................................................... 6 Other Potential Measures .................................................................................................................................................... 7 Technical Specifications Overview .......................................................................................................................................... 7 Testing and Implementation of the Measurement Set .......................................................................................................... 7 2016 Neuro-Oncology Measure Specifications and Flow Sheets ........................................................................................... 8 Multidisciplinary Care Plan Developed for Primary Brain or Spine Tumors ..................................................................... 8 Molecular Testing in Accordance with World Health Organization Classification of Tumors of the Central Nervous System ............................................................................................................................................................................... 14 Chemotherapy Education and Informed Consent for Brain Tumor Patients .................................................................... 18 Intra-Operative or Post-Operative MRI for Gliomas ........................................................................................................ 23 Venous Thromboembolism Events (VTE) Following Primary Brain Tumor Surgery ..................................................... 27 Contact Information .............................................................................................................................................................. 31 Appendix A AAN Statement on Comparing Outcomes of Patients....................................................................................... 32 Appendix B Disclosures ......................................................................................................................................................... 33 ©2017. American Academy of Neurology Institute and Society for Neuro-Oncology. All Rights Reserved. CPT® Copyright 2004-2017 American Medical Association. 2 Disclaimer Performance Measures (Measures) and related data specifications developed by the American Academy of Neurology Institute (AANI) and Society for Neuro-Oncology (SNO) are intended to facilitate quality improvement activities by providers. AAN and SNO Measures: 1) are not clinical guidelines and do not establish a standard of medical care, and have not been tested for all potential applications; 2) are not continually updated and may not reflect the most recent information; and 3) are subject to review and may be revised or rescinded at any time by the AAN. The measures, while copyrighted, can be reproduced and distributed, without modification, for noncommercial purposes (e.g., use by health care providers in connection with their practices); they must not be altered without prior written approval from the AAN. Commercial use is defined as the sale, license, or distribution of the measures for commercial gain, or incorporation of the measures into a product or service that is sold, licensed, or distributed for commercial gain. Commercial uses of the measures require a license agreement between the user and the AAN. Neither the AAN nor its members or the SNO nor its members are responsible for any use of the measures. AAN Measures and related data specifications do not mandate any particular course of medical care and are not intended to substitute for the independent professional judgment of the treating provider, as the information does not account for individual variation among patients. In all cases, the selected course of action should be considered by the treating provider in the context of treating the individual patient. Use of the information is voluntary. AAN and SNO provide this information on an “as is” basis, and make no warranty, expressed or implied, regarding the information. AAN and SNO specifically disclaim any warranties of merchantability or fitness for a particular use or purpose. AAN and SNO assume no responsibility for any injury or damage to persons or property arising out of or related to any use of this information or for any errors or omissions. © 2017 American Academy of Neurology Institute and Society for Neuro-Oncology. All rights reserved. Limited proprietary coding is contained in the measure specifications for convenience. Users of the proprietary coding sets should obtain all necessary licenses from the owners of these code sets. The AAN and its members disclaim all liability for use or accuracy of any Current Procedural Terminology (CPT®) or other coding contained in the specifications. ICD-10 copyright 2012 International Health Terminology Standards Development Organization CPT ® is a registered trademark of the American Medical Association and is copyright 2012. CPT® codes contained in the Measure specifications are copyright 2004-2013 American Medical Association. ©2017. American Academy of Neurology Institute and Society for Neuro-Oncology. All Rights Reserved. CPT® Copyright 2004-2017 American Medical Association. 3 Work Group Members American Academy of Neurology and Society for Neuro-Oncology Justin T. Jordan, MD, MPH Pappas Center for Neuro-Oncology, Massachusetts General Hospital, Boston, MA American Academy of Neurology Nimish Mohile, MD Department of Neurology, University of Rochester, Rochester, NY Douglas E. Ney, MD Departments of Neurology and Neurosurgery, University of Colorado School of Medicine, Aurora, CO P. Leia Nghiemphu, MD Department of Neurology, UCLA, Los Angeles, CA American Association of Neurological Surgeons/Congress of Neurological Surgeons Tony Asher, MD Department of Neurological Surgery, Carolinas Medical Center Carolina Neurosurgery and Spine Associates, Charlotte, NC Society for Neuro-Oncology Terri Armstrong, PhD, ANP-BC, FAAN, FAANP Neuro-Oncology Branch, Center for Clinical Research, National Cancer Institute, National Institutes of Health, Bethesda, MD Erin Dunbar, MD Department of Neuro-Oncology, Piedmont Brain Tumor Center, Atlanta, GA Timothy R. Smith, MD, PhD, MPH Cushing Neurosurgical Outcomes Center, Brigham & Women’s Hospital, Harvard Medical School, Boston, MA Facilitator Amy E. Sanders, MD, MS, FAAN Department of Neurology, SUNY Upstate Medical University, Syracuse, NY American Academy of Neurology Staff Amy Bennett, JD Gina Gjorvad Katie Hentges Erin Lee Becky Schierman, MPH Society for Neuro-Oncology Staff J. Charles Haynes, JD Carolyn Loch, RN ©2017. American Academy of Neurology Institute and Society for Neuro-Oncology. All Rights Reserved. CPT® Copyright 2004-2017 American Medical Association. 4 Improving Outcome for Patients with Neuro-Oncology Conditions Rationale for Measures The American Academy of Neurology (AAN) and Society of Neuro-Oncology (SNO) charged this work group with developing measures focused on improving outcomes for patients diagnosed with a neuro-oncology condition. As required, all members disclosed relationships with industry and other entities to avoid actual, potential, or perceived conflicts of interest. Importance and Prevalence of Neuro-Oncology In the United States, it is estimated that nearly 78,000 new cases of brain tumors are diagnosed yearly with approximately 53,000 non-malignant and 25,000 primary malignant brain tumors.i In 2015, it was estimated that 22,850 people in the U.S. would be diagnosed with primary malignant brain or other central nervous system (CNS) neoplasms, and these tumors would be responsible for approximately 15,320 deaths. ii Glioblastomas are the most common malignant primary brain tumor, while meningioma are the most frequently reported intracranial tumor.iii Gliomas account for 29% of all tumors and 82% of malignant tumors.iv In a review of National Cancer