CMS-10431 EBRT Paper based

PPS-Exempt Cancer Hospital Quality Reporting (PCHQR) Program

Paper-Based Form

Online Data Entry Tool Content for FY 2017 and Subsequent Years

CCN Hospital Name

(NQF 1822) External Beam Radiotherapy for Bone Metastases

This measure reports the percentage of patients, regardless of age, with a diagnosis of painful bone metastases and no history of previous radiation who receive external beam radiation therapy (EBRT) with an acceptable fractionation scheme.

Q1 Q2 Q3 Q4

NUMERATOR

All patients, regardless of age, with painful bone metastases, and no previous radiation to the same anatomic site who receive EBRT with any of the following recommended fractionation schemes: 30Gy/10fxns, 24Gy/6fxns, 20Gy/5fxns, 8Gy/1fxn.

Q1 Q2 Q3 Q4

DENOMINATOR

All patients with painful bone metastases and no previous radiation to the same anatomic site who receive EBRT.

Q1 Q2 Q3 Q4

Percent of Total

Please refer to specifications on the National Quality Forum website: http://www.qualityforum.org/QPS/1822.

Complete and submit this form via email to: [email protected].

Following receipt of the request form, an email acknowledgement will be sent confirming the form has been received.

PRA Disclosure Statement
According to the Paperwork Reduction Act of 1995, no persons are required to respond to a collection of information unless it displays a valid OMB control number. The valid OMB control number for this information collection is 0938-1175. The time required to complete this information collection is estimated to average 10 minutes per response, including the time to review instructions, search existing data resources, gather the data needed, and complete and review the information collection. If you have comments concerning the accuracy of the time estimate(s) or suggestions for improving this form, please write to: CMS, 7500 Security Boulevard, Attn: PRA Reports Clearance Officer, Mail Stop C4-26-05, Baltimore, Maryland 21244-1850.

03/05/2014 ERBT