ABIM Cancer Screening PIM™ Practice Improvement Module Measures Catalogue - American Board of Internal Medicine

ABIM Cancer Screening PIM™
Practice Improvement Module
Measures Catalogue

Cancer Screening Measures Catalogue
September 2010

TABLE OF CONTENTS

Introduction ............................................................................................................................................ 3

Processes of Care

Physical Examination........................................................................................................................................... 6

Appropriate Documentation of Habits, Exposures, and Risks ...........................................................................................6

Appropriate Counseling and Referrals .................................................................................................................................8

Screenings, Tests & Evaluations...........................................................................................................................................9

Patient-Centered Care ..........................................................................................................................................................11

Potential Overuse .................................................................................................................................................................12

Patient Experience: Processes of Care

Appropriate Documentation of Habits, Exposures, and Risks ................................................................................ 14

Appropriate Counseling and Referrals ...............................................................................................................................14

Patient-Centered Care ..........................................................................................................................................................15

Patient Satisfaction...............................................................................................................................................................16

Access to the Practice..........................................................................................................................................................17

Cancer Screening Measure Catalog September 2010 Page 2 of 19

Introduction:

This catalogue provides information related to the American Board of Internal Medicine’s Cancer Screening Practice
Improvement Module®. It is written in language that addresses the physician who might choose to complete this module, and it
details the specifics of the module. Included is information regarding:

• Purpose and structuring of the module
• Patient inclusion criteria
• Detailed description of the measures

This PIM examines the care you provide to your patients by addressing key processes and outcomes of preventive care based on
recommendations of the U.S. Preventive Services Task Force, the National Cancer Institute, the American Cancer Society, and the
American College of Radiology.

The PIM is divided into three parts, with multiple sections in each part.

Part 1 -Performance Data
Provide baseline data about your practice's current performance by...

• Surveying your patients
• Reviewing your charts
• Assessing your practice systems

The 17 patient survey measures and 31 chart review measures are summarized below. ABIM requires a minimum of 25 patient
surveys and a minimum of 25 chart reviews.

The practice systems assessment is comprised of multiple pages of questions covering various aspects of practice structure and
protocols.

Patients can be included in this module if all of the following are true:


1. Patients are age 40 and older;
2. Management decisions regarding their cancer screenings are made primarily by providers in the practice;
3. They have been patients in the practice for at least one year; AND
4. They have been seen by the practice within the past 12 months.

Patients should be excluded from this module if the following is true:

1. They are unable to complete the patient survey, even with assistance.
OR
2. They have a terminal illness, or cancer screening is not indicated because of limited life expectancy.

Part 2 - Quality Improvement (QI) Plan
Develop a plan for improving one aspect of your practice after reviewing the analysis of your current performance data. The analysis
will include many aspects of care you provide to your patients. Ultimately, you will target only one of these to use in this quality
improvement (QI) cycle.

Part 3 - Remeasurement
Remeasure your performance data after you have implemented your QI plan to see if you achieved your goal. Then, you will reflect on
the process of developing and implementing a QI plan.

You may claim CME credit for completing this activity. The University of Pennsylvania School of Medicine designates this
educational activity for a maximum of 20 AMA PRA Category 1 Credit(s)TM.


Cancer Screening - PROCESSES OF CARE

Documentation of Family History
Measure Title Description Numerator Denominator Rationale
Medical record Female patients in the sample Number of female patients in the Number of female The risk conferred by a family
documents whether or whose medical record sample whose medical record patients in the history of breast cancer has been
not patient has a family documented whether or not documented whether or not sample. assessed in both case-control and
history of breast cancer patient has a family history of patient has a family history of cohort studies, using volunteer and
breast cancer. breast cancer. population-based samples, with
generally consistent results. In a
pooled analysis of 38 studies, the
relative risk (RR) of breast cancer
conferred by a first-degree relative
with breast cancer was 2.1. Risk
increases with the number of
affected relatives, and when the
affected relatives are of younger
age at diagnosis.
Medical record Female patients in the sample Number of female patients in the Number of female The single greatest ovarian cancer
documents whether or whose medical record sample whose medical record patients in the risk factor is a family history of the
not patient has a family documented whether or not documented whether or not sample. disease. A large meta-analysis of
history of ovarian patient has a family history of patient has a family history of 15 published studies estimated an
cancer ovarian cancer. ovarian cancer. odds ratio (OR) of 3.1 for the risk of
ovarian cancer associated with at
least one first-degree relative with
ovarian cancer.
Medical record Male patients in the sample Number of male patients in the Number of male Men with a family history of
documents whether or whose medical record sample whose medical record patients in the prostate cancer are at increased
not patient has a family documented whether or not documented whether or not sample. risk for diagnosis of and death from
history of prostate patient has a family history of patient has a family history of prostate cancer
cancer prostate cancer. prostate cancer.
Medical record Patients in the sample whose Number of patients in the sample Number of patients Numerous studies that have
documents whether or medical record documented whose medical record in the sample. consistently found that there is a
not patient has a family whether or not patient has a documented whether or not twofold to threefold increased risk of
history of colon cancer family history of colon cancer or patient has a family history of colorectal cancer in people with
or adenomatous polyps adenomatous polyps. colon cancer or adenomatous first-degree relatives affected with
polyps. the disease. Persons with a family
history of adenomatous polyps may
also have an increased risk of
colorectal cancer.


CANCER SCREENING - PROCESSES OF CARE

Physical Examination


Height Patients in the sample with Number of patients in the sample Number of patients
height documented who have height documented in the sample.

Weight Patients in the sample with Number of patients in the sample Number of patients
weight documented. who have weight documented. in the sample.

Appropriate Documentation of Habits, Exposures, and Risks


Medical record Patients in the sample whose Number of patients in the sample Number of patients The routine and thorough
documents information current smoking status was whose current smoking status in the sample. assessment of tobacco use is
about patients’ smoking documented. was documented. important as a means of preventing
status smoking or encouraging cessation.

Medical record Patients in the sample who are Number of patients in the sample Number of patients The routine and thorough
documents information current non-smokers whose who are current non-smokers in the sample who assessment of tobacco use is
about patients’ former former smoking status was whose former smoking status are current non- important as a means of preventing
smoking status documented. was documented. smokers. smoking or encouraging cessation.

Medical record Patients in the sample who are Number of patients in the sample Number of patients Secondhand smoke is classified as
documents information current non-smokers whose who are current non-smokers in the sample who a "known human carcinogen"
about patients’ exposure to second-hand smoke whose exposure to second-hand are current non- (cancer-causing agent) by the U.S.
exposure to second- was documented. smoke was documented. smokers. Environmental Protection Agency
hand smoke (EPA), the U.S. National Toxicology
Program, and the International
Agency for Research on Cancer
(IARC).

Medical record Patients in the sample whose Number of patients in the sample Number of patients Good evidence has been found that
documents information status regarding alcohol use whose status regarding alcohol in the sample. screening regarding alcohol use can
about patients’ status (current, former, or non-user) use (current, former, or non- accurately identify patients whose
regarding alcohol use was documented. user) was documented. levels or patterns of alcohol
(current, former, or non- consumption place them at risk for
user) increased morbidity and mortality.

Medical record Patients in the sample whose Number of patients in the sample Number of patients Higher levels of alcohol
documents information current level of alcohol use was whose current level of alcohol in the sample, consumption have been linked to




about patients’ current documented. use was documented. excluding patients increased risk for cancers of the
level of alcohol use who do not currently head and neck, digestive tract, liver,
drink or have never and breast, as well as cirrhosis,
consumed alcohol. diseases of the central nervous
system, and hypertension.

Medical record Patients in the sample whose Number of patients in the sample Number of patients Epidemiologic research has shown
documents information prior history of level of alcohol whose prior history of level of in the sample, a dose-dependent association
about patients’ prior use was documented. alcohol use was documented. excluding patients between alcohol consumption and
history of alcohol use who have never certain types of cancer, as well as
consumed alcohol. other health problems.

Medical record Patients in the sample whose Number of patients in the sample Number of patients A sexual history is important for all
documents information sexual history was documented. whose sexual history was in the sample. patients to provide information that
about patients’ sexual documented. identifies those at risk for sexually
history transmitted diseases, including HIV,
and to guide risk-reduction
counseling.

Medical record Patients in the sample whose Number of patients in the sample Number of patients A sexual history is important for all
documents information risk for acquiring a sexually whose risk for acquiring a in the sample. patients to provide information that
about patients’ risk for transmitted infection was sexually transmitted infection identifies those at risk for sexually
acquiring a sexually documented. was documented transmitted diseases, including HIV,
transmitted infection and to guide risk-reduction
counseling.

Medical record Patients in the sample whose Number of patients in the sample Number of patients Many epidemiologic studies indicate
documents information current or prior occupational whose current or prior in the sample. an association between
about patients’ current exposures that could affect occupational exposures that occupational exposures and specific
or prior occupational health were documented. could affect health were types of cancer.
exposures that could documented.
affect health


Appropriate Counseling and Referrals


Referral to a Obese patients in the sample Number of obese patients in the Number of patients There is fair to good evidence that
multidisciplinary who were reported as being sample who were reported as in the sample who programs offering intensive
program to address referred to a multidisciplinary being referred to a are obese. When counseling and behavioral
risks of obesity program to address risks of multidisciplinary program to height and weight interventions produce modest but
obesity. address risks of obesity. were both available, sustained weight loss in obese
this was defined as a adults.
BMI of >=30 kg/m2.
When height and/or
weight were not
available, the
physician's
assessment of body
habitus as "obese"
was used.

Discussion of risks and Patients in the sample, excluding Number of patients in the Number of patients There is good evidence that
potential benefits of patients who have never sample, excluding patients who in the sample, screening and behavioral
alcohol use consumed alcohol, who were have never consumed alcohol, excluding patients counseling for alcohol misuse
reported as having a discussion who were reported as having a who have never benefits patients.
of risks and potential benefits of discussion of risks and potential consumed alcohol.
alcohol use. benefits of alcohol use.

Referral for high- Patients in the sample at high Number of patients in the sample Number of patients There is convincing evidence that
intensity behavioral risk for STIs who were reported at high risk for STIs who were in the sample at high high-intensity behavioral counseling
counseling to reduce as having received high-intensity reported as having received risk for STIs. interventions targeted to sexually
the risk of sexually behavioral counseling to reduce high-intensity behavioral active adolescents and adults at
transmitted infections the risk of sexually transmitted counseling to reduce the risk of increased risk for STIs reduce the
infections. sexually transmitted infections. incidence of STIs.

Smoking cessation Patients in the sample who are Number of patients in the sample Number of patients A number of large randomized
support within the past smokers and who received who are smokers and who in the sample who clinical trials have demonstrated the
12 months smoking cessation counseling or received smoking cessation are smokers. efficacy and cost-effectiveness of
treatment during the 12 month counseling or treatment during smoking cessation counseling in
period prior to the visit date, with the 12 month period prior to the changing smoking behavior and
a three-month grace period. visit date, with a three-month reducing tobacco use. The routine
grace period. and thorough assessment of
tobacco use is an important step in
smoking cessation counseling.


Screenings, Tests & Evaluations


Colorectal cancer Patients in the sample 40 to 75 Number of patients in the sample Number of patients Colorectal cancer is the third most
screening in patients 40 years old who were reported as 40 to 75 years old with a family in the sample 50 to common type of cancer and the
to 75 years old that having colorectal cancer history of colorectal cancer or 75 years old AND second leading cause of cancer
complies with screening that complies with adenomatous polyps who were patients 40 to 75 death in the United States. The
guidelines guidelines. Patients with a reported as having a years old who have evidence is convincing that
personal history of colorectal colonoscopy within 60 months, a family history of screening for colorectal cancer with
cancer or adenomatous polyps plus three month grace period colorectal cancer or fecal occult blood testing,
are excluded from this measure. OR patients 50 to 75 without a adenomatous sigmoidoscopy, or colonoscopy
personal or family history of polyps, excluding detects early-stage cancer and
colorectal cancer or those patients with a adenomatous polyps and reduces
adenomatous polyps who were personal history of colorectal cancer mortality. The
reported as having 1) a colorectal cancer or evidence base regarding a mortality
colonoscopy within 120 months, adenomatous benefit for newer screening
plus three month grace period; polyps. modalities is still developing.
OR 2) a high sensitivity guaiac-
based FOBT within 12 months,
plus three month grace period;
OR 3) a flexible sigmoidoscopy
within 60 months plus three
month grace period AND a high
sensitivity guaiac-based FOBT
or a FIT within 36 months, plus
three month grace period; OR 4)
a CT colonography within 60
months, plus three month grace
period; OR 5) a DCBE within 60
period; OR 6) a FIT within 12
period; OR 7) a high-sensitivity
fecal DNA testing within 60
period.

Pap smear for cervical Female patients in the sample Number of female patients in the Number of female Good evidence from multiple
cancer screening within 40 to 65 years old and female sample 40 to 65 years old and patients in the observational studies has shown
three years (every year patients age 66 and older at high female patients age 66 and older sample 40 to 65 that screening with cervical cytology
for patients with risk for STIs who were reported at high risk for STIs without years old and female (Pap smears) reduces incidence of
HIV/AIDS) as having a pap smear for HIV/AIDS who were reported as patients age 66 and and mortality from cervical cancer.
cervical cancer screening 1) having a pap smear for cervical older at high risk for




within 36 months, plus three cancer screening 1) within 36 STIs, excluding
month grace period for those months, plus three month grace those who were not
without HIV/AIDS, OR 2) within period for those without tested because they
12 months, plus three month HIV/AIDS, OR 2) within 12 have no cervix.
grace period for those with months, plus three month grace
HIV/AIDS. period for those with HIV/AIDS,
excluding those who were not
tested because they have no
cervix.

Mammography for Female patients in the sample Number of female patients in the Number of female Breast cancer is the second-leading
breast cancer screening 40 to 49 years old without a sample 40 to 49 years old patients in the cause of cancer death among
within two years: personal history of breast cancer without a personal history of sample 40 to 49 women in the United States. There
women age 40 to 49 in the sample who were reported breast cancer in the sample who years old without is convincing evidence that
as having a mammography for were reported as having a personal history of screening with film mammography
breast cancer screening within mammography for breast cancer breast cancer. reduces breast cancer mortality,
24 months, plus three month screening within 24 months, plus with a greater absolute reduction for
grace period. three month grace period. women aged 50 to 74 years than for
women aged 40 to 49 years. The
strongest evidence for the greatest
benefit is among women aged 60 to
69 years. Among younger women,
meta-analyses of randomized,
controlled trials demonstrate a 7%
to 23% reduction in breast cancer
mortality rates from screening
mammography in women 40 to 49
years of age.

Mammography for Female patients in the sample Number of female patients in the Number of female Breast cancer is the second-leading
breast cancer screening age 50 and over without a sample age 50 and over without patients in the cause of cancer death among
within two years: personal history of breast cancer a personal history of breast sample age 50 and women in the United States. There
women age 50 and who were reported as having a cancer who were reported as over without a is convincing evidence that
over mammography for breast cancer having a mammography for personal history of screening with film mammography
screening within 24 months, plus breast cancer screening within breast cancer. reduces breast cancer mortality,
three month grace period. 24 months, plus three month with a greater absolute reduction for
grace period. women aged 50 to 74 years than for
women aged 40 to 49 years. The
strongest evidence for the greatest
benefit is among women aged 60 to
69 years.




Prostate cancer testing Male patients in the sample 50 to Number of male patients in the Number of male Prostate cancer is the most
done for those desiring 74 years old OR male African sample 50 to 74 years old OR patients in the common non-skin cancer and the
testing, age 50 to 74 American patients 45 to 74 years male African American patients sample 50 to 74 second leading cause of cancer
(45 to 74 for African old OR male patients 40 to 74 45 to 74 years old OR male years old OR male death in men in the United States.
Americans and 40 to 74 years old with a family history of patients 40 to 74 years old with a African American Because current evidence is
with a family history of prostate cancer who were family history of prostate cancer patients 45 to 74 insufficient to determine if the
prostate cancer) reported as desiring prostate who were reported as desiring years old OR male benefits of screening for prostate
cancer screening and having prostate cancer screening and patients 40 to 74 cancer outweigh the risks, the
screening done within 12 having screening done within 12 years old with a decision about screening should be
months, plus three month grace months, plus three month grace family history of shared by an individual patient and
period. period. prostate cancer who his physician.
were reported as
desiring to have
screening for
prostate cancer.

HIV infection (includes Patients in the sample 40 to 64 Number of patients in the sample Number of patients Early identification and treatment for
patients who received years old who were reported as 40 to 64 years old who were in the sample 40 to HIV provides substantial health
test and those who having been tested for HIV reported as having been tested 64 years old, benefit by extending the length of
were offered but infection OR being offered but for HIV infection OR being excluding those who life of the person identified as
declined testing) declined testing, excluding those offered but declined testing, were not offered HIV having HIV.
who were not offered testing excluding those who were not testing because local
because local prevalence is offered testing because local prevalence is
<1:1,000 and those with prevalence is <1:1,000 and <1:1,000 and those
HIV/AIDS. those with HIV/AIDS. with HIV/AIDS.

Patient-Centered Care
Medical record Applicable patients in the sample Number of applicable patients in Number of male Because current evidence is
documents patient who were reported as having an the sample who were reported as patients in the sample insufficient to determine if the
preferences concerning assessment of preferences having an assessment of age 50 to 74 OR male benefits of screening for prostate
prostate cancer regarding prostate cancer preferences regarding prostate African American cancer outweigh the risks, most
screening screening. cancer screening. Applicable patients age 45 to 74 major U.S. medical organizations
patients are male patients age 50 OR male patients age recommend that clinicians discuss
to 74 OR male African American 40 to 74 with a family the potential benefits and known
patients age 45 to 74 OR male history of prostate harms of PSA screening with their
patients age 40 to 74 with a family cancer, excluding patients, consider their patients'
history of prostate cancer, those who have a preferences, and individualize
excluding those who have been personal history of screening decisions.
diagnosed with prostate cancer. prostate cancer.


Potential Overuse
Colorectal cancer Patients in the sample 76 to 85 Number of patients in the sample Number of patients There is adequate evidence that the
screening in patients 76 years old who were reported as 76 to 85 years old who were in the sample 76 to benefits of detection of colorectal
to 85 having colorectal cancer reported as having colorectal 85 years old without cancer and early intervention
screening at a date when cancer screening at a date when a personal history of decline after age 75 years. The lead
patients were age 76 and over, patients were age 76 and over, colorectal cancer or time between the detection and
excluding those who have a excluding those who have a adenomatous treatment of colorectal neoplasia
personal history of colorectal personal history of colorectal polyps. and a mortality benefit is
cancer or adenomatous polyps. cancer or adenomatous polyps. substantial, and competing causes
of mortality make it progressively
less likely that this benefit will be
realized with advancing age.
Colorectal cancer Patients in the sample age 86 Number of patients in the sample Number of patients The USPSTF concludes that, for
screening in patients 86 and over who were reported as age 86 years and over who were in the sample age 86 adults older than age 85 years,
and over having colorectal cancer reported as having colorectal and over without a there is moderate certainty that the
screening at a date when cancer screening at a date when personal history of benefits of screening do not
patients were age 86 and over, patients were age 86 and over, colorectal cancer or outweigh the harms, and these
excluding those who have a excluding those who have a adenomatous patients should not undergo
personal history of colorectal personal history of colorectal polyps. screening.
cancer or adenomatous polyps. cancer or adenomatous polyps.
Cervical cancer Female patients in the sample Number of female patients in the Number of female The USPSTF found limited
screening in women 66 age 66 and over who were not at sample age 66 and over who patients in the evidence to determine the benefits
and over high risk for acquiring STIs and were not at high risk for sample age 66 and of continued screening in women
not having HIV/AIDS and who acquiring STIs and not having older, EXCEPT older than 65. The yield of
were reported as having cervical HIV/AIDS and who were those at high risk for screening is low in previously
cancer screening at a date when reported as having cervical STI, having screened women older than 65 due
patients were age 66 and over. cancer screening at a date when HIV/AIDS, and to the declining incidence of high-
Patients who have no cervix are patients were age 66 and over. having no cervix. grade cervical lesions after middle
excluded. Patients who have no cervix are age. There is fair evidence that
excluded. screening women older than 65 is
associated with an increased risk
for potential harms, including false-
positive results and invasive
procedures. The USPSTF
concludes that the potential harms
of screening are likely to exceed
benefits among older women who
have had normal results previously
and who are not otherwise at high
risk for cervical cancer.


Potential Overuse
Prostate cancer Male patients in the sample 50 to Number of male patients in the Number of male Because current evidence is
screening in men 50 to 74 years old OR male African sample 50 to 74 years old OR patients in the insufficient to determine if the
74 (45 to 74 for African American patients 45 to 74 years male African American patients sample 50 to 74 benefits of screening for prostate
Americans and 40 to 74 old OR male patients years old 45 to 74 years old OR male years old OR male cancer outweigh the risks, most
with a family history of 40 to 74 with a family history of patients 40 to 74 years old with a African American major U.S. medical organizations
prostate cancer) who prostate cancer who were family history of prostate cancer patients 45 to 74 recommend that clinicians discuss
did not desire screening reported as not desiring prostate who were reported as not years old OR male the potential benefits and known
or in whom preference cancer screening OR in whom desiring prostate cancer patients 40 to 74 harms of PSA screening with their
was not assessed preference were not assessed, screening OR in whom years old with a patients, consider their patients'
but had prostate cancer preference were not assessed, family history of preferences, and individualize
screening. but had prostate cancer prostate cancer who screening decisions. It follows that
screening. did not desire testing patients who do not desire prostate
OR in whom cancer screening should not have it
preference were not done, and that physicians should
assessed. not act unilaterally prior to
assessing patient preferences.
Prostate cancer Male patients in the sample age Number of male patients in the Number of male In men age 75 years or older, the
screening in men 75 75 and over without a personal sample age 75 and over without patients in the USPSTF found adequate evidence
and over history of prostate cancer who a personal history of prostate sample age 75 and that the incremental benefits of
had prostate cancer screening at cancer who had prostate cancer older without a treatment for prostate cancer
a date when patients were age screening at a date when personal history of detected by screening are small to
75 and over. patients were age 75 and over. prostate cancer. none, and that these patients
should not undergo screening.


PATIENT EXPERIENCE: CANCER SCREENING – PROCESSES OF CARE



Patient recalls being Patients in the sample who Number of patients in the sample Number of patients Good evidence has been found that
asked about patients’ reported being asked if patient who reported being asked if in the sample. To be screening regarding alcohol use can
status regarding alcohol drinks alcohol. patient drinks alcohol. included in the accurately identify patients whose
use. sample, patients levels or patterns of alcohol
need to be 40 and consumption place them at risk for
older. increased morbidity and mortality.

Patient recalls being Patients in the sample who Number of patients in the sample Number of patients A sexual history is important for all
asked for information reported being asked for who reported being asked for in the sample. To be patients to provide information that
about patients’ sexual information about patients’ information about patients’ included in the identifies those at risk for sexually
history sexual history in the past 12 sexual history in the past 12 sample, patients transmitted diseases, including HIV,
months. months. need to be 40 and and to guide risk-reduction
older. counseling.

Patient recalls being Patients in the sample who Number of patients in the sample Number of patients Many epidemiologic studies indicate
asked for information reported being asked for who reported being asked for in the sample. To be an association between
about patients’ work information about patients’ work information about patients’ work included in the occupational exposures and specific
history history. history. sample, patients types of cancer.
need to be 40 and
older.



Patient reports being Patients in the sample who are Number of patients in the sample Number of patients There is convincing evidence that
advised to stop current smokers who reported who are current smokers who in the sample who smoking cessation interventions,
smoking that their doctor had advised reported that their doctor had reported that they beginning with advising patients to
them more than once to stop advised them more than once to currently smoke stop smoking, are effective in
smoking cigarettes. stop smoking cigarettes cigarettes. To be increasing the likelihood that
included in the smokers successfully quit.
sample, patients
need to be 40 and
older.

Patient reports being Patients in the sample who are Number of patients in the sample Number of patients There is convincing evidence that
offered smoking current smokers who reported who are current smokers who in the sample who smoking cessation interventions,
cessation that their doctor had offered reported that their doctor had reported that they are effective in increasing the
assistance/counseling smoking cessation assistance or offered smoking cessation currently smoke likelihood that smokers successfully




counseling. assistance or counseling. cigarettes. To be quit. The key elements of effective
included in the smoking cessation counseling
sample, patients include identifying tobacco users,
need to be 40 and offering consistent and repeated
older. cessation advice that is of personal
medical relevance, adjuncts such as
nicotine replacement therapy (NRT),
follow-up contact, and advice
regarding intensive cessation
therapy.



Patient reports being Male patients in the sample age Number of male patients in the Number of male Because current evidence is
shared decision-making 50 and older who reported that sample age 50 and older who patients in the insufficient to determine if the
about prostate cancer they were shared decision- reported that they were shared sample who were benefits of screening for prostate
screening making about prostate cancer decision-making about prostate age 50 and older, cancer outweigh the risks, most
screening, excluding those who cancer screening, excluding excluding those who major U.S. medical organizations
have a personal history of those who have a personal have a personal recommend that clinicians discuss
prostate cancer. history of prostate cancer. history of prostate the potential benefits and known
cancer. harms of PSA screening with their
patients, consider their patients'
preferences, and individualize
screening decisions.

Patient reports being Female patients in the sample Number of female patients in Number of female
shared decision- age 40 to 49 who reported that the sample age 40 to 49 who patients in the
making about they were shared decision- reported that they were shared sample age 40 to
mammography making about mammography, decision-making about 49, excluding those
excluding those who have a mammography, excluding who have a
personal history of breast those who have a personal personal history of
cancer. history of breast cancer. breast cancer.

recommended age 50 and older who reported the sample age 50 and older patients in the
mammogram to that they were recommended who reported that they were sample age 50 and
screen for breast mammogram to screen for recommended mammogram to older, excluding
cancer breast cancer, excluding those screen for breast cancer, those who have a
who have a personal history of excluding those who have a personal history of




breast cancer. personal history of breast breast cancer.
cancer.

recommended pap age 65 and younger who were the sample age 65 and younger patients in the
smear to screen for recommended pap smear to who were recommended pap sample age 65 and
cervical cancer screen for cervical cancer, smear to screen for cervical younger, excluding
excluding those who have a cancer, excluding those who those who have a
personal history of cervical have a personal history of personal history of
cancer. cervical cancer. cervical cancer.

Patient reports being Patients in the sample age 50 Number of patients in the Number of patients
recommended and older who were sample age 50 and older who in the sample who
screening test for recommended screening test were recommended screening were age 50 and
colorectal cancer for colorectal cancer, excluding test for colorectal cancer, older, excluding
those who have a personal excluding those who have a those who have a
history of colorectal cancer. personal history of colorectal personal history of
cancer. colorectal cancer.

Patient Satisfaction


Practice is excellent at Patients in the sample who Number of patients in the sample Number of patients Care should be patient-centered,
encouraging questions reported that practice is excellent who responded "excellent" to the in the sample. To be respectful of and responsive to
and answering them at encouraging questions and question "How is this practice at included in the individual patient preferences,
clearly answering them clearly encouraging you to ask sample, patients needs, and values. Patients' overall
questions and answering them need to be 40 and experiences with doctors are
clearly?" older. shaped by communication style and
content. Both contribute to the
likelihood that a patient will
understand and be able to follow
treatment recommendations.

Patient would Patients in the sample who Number of patients in the sample Number of patients Consumer satisfaction with
recommend practice to reported that they would who responded "Yes" to the in the sample. To be healthcare is recognized as a
others recommend the practice to survey question, "Would you included in the measure of quality.
family or friends. recommend this practice to sample, patients
family or friends?" need to be 40 and
older.


Access to the Practice


Patient reports no Patients in the sample who Number of patients in the sample Number of patients The Institute of Medicine
problem with report no problems scheduling who responded "Not a problem" in the sample, recommends that patients should
scheduling appointments with the practice. to the survey question, "In the excluding those who receive care whenever they need it
appointments past 12 months, how much of a responded "Not and in many forms, not just face-to-
problem has it been to schedule applicable" to the face visits. This implies that the
appointments with this practice?" survey question, "In health care system should be
To be included in the sample, the past 12 months, responsive at all times (24 hours a
patients need to be between the how much of a day, every day) and that access to
ages of 40 and 110. problem has it been care should be provided over the
to schedule Internet, by telephone, and by other
appointments with means in addition to face-to-face
this practice?" To visits.
be included in the
sample, patients
need to be between
the ages of 40 and
110.

problem with reaching report no problems reaching the who responded "Not a problem" in the sample, recommends that patients should
someone with a practice with questions or to the survey question, "In the excluding those who receive care whenever they need it
question concerns. past 12 months, how much of a responded "Not and in many forms, not just face-to-
problem has it been to reach this applicable" to the face visits. This implies that the
practice when you have a survey question, "In health care system should be
question or concern?" To be the past 12 months, responsive at all times (24 hours a
included in the sample, patients how much of a day, every day) and that access to
need to be between the ages of problem has it been care should be provided over the
40 and 110. to reach this practice Internet, by telephone, and by other
when you have a means in addition to face-to-face
question or visits.
concern?" To be
included in the
sample, patients
need to between the
ages of 40 and 110.
problem with obtaining report no problems obtaining who responded "Not a problem" in the sample, recommends that patients should
prescription refills prescription refills from the to the survey question, "In the excluding those who receive care whenever they need it
practice. past 12 months, how much of a responded "Not and in many forms, not just face-to-




problem has it been to get a applicable" to the face visits. This implies that the
prescription refill from this survey question, "In health care system should be
practice?" To be included in the the past 12 months, responsive at all times (24 hours a
sample, patients need to be how much of a day, every day) and that access to
between the ages of 40 and 110. problem has it been care should be provided over the
to get a prescription Internet, by telephone, and by other
refill from this means in addition to face-to-face
practice?" To be visits.
included in the
sample, patients
need to be between
the ages of 40 and
110.

problem with obtaining report no problems obtaining test who responded "Not a problem" in the sample, recommends that patients should
test results results from the practice. to the survey question, "In the excluding those who receive care whenever they need it
past 12 months, how much of a responded "Not and in many forms, not just face-to-
problem has it been to get your applicable" to the face visits. This implies that the
laboratory test results from this survey question, "In health care system should be
practice?" To be included in the the past 12 months, responsive at all times (24 hours a
sample, patients need to be how much of a day, every day) and that access to
between the ages of 40 and 110. problem has it been care should be provided over the
to get your Internet, by telephone, and by other
laboratory test means in addition to face-to-face
results from this visits.
practice?" To be
included in the
sample, patients
need to be between
the ages of 40 and
110.

problem with obtaining report no problems obtaining who responded "Not a problem" in the sample, recommends that patients should
referrals referrals from the practice. to the survey question, "In the excluding those who receive care whenever they need it
past 12 months, how much of a responded "Not and in many forms, not just face-to-
problem has it been to get a applicable" to the face visits. This implies that the
referral from this practice?" To survey question, "In health care system should be
be included in the sample, the past 12 months, responsive at all times (24 hours a
patients need to be between the how much of a day, every day) and that access to




ages of 40 and 110. problem has it been care should be provided over the
to get a referral from Internet, by telephone, and by other
this practice?" To means in addition to face-to-face
be included in the visits.
sample, patients
need to be between
the ages of 40 and
110.

© 2010 American Board of Internal Medicine. All rights reserved. ABIM publications are protected by United States and international copyright laws. Written permission for any reproduction or
adaptation, in whole or in part, in any format or medium must be obtained from ABIM. Contact request@abim.org.


ABIM Cancer Screening PIM™ Practice Improvement Module Measures Catalogue - American Board of Internal Medicine

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ABIM Cancer Screening PIM™ Practice Improvement Module Measures Catalogue - American Board of Internal Medicine