mm3-questions.txt

# Questions for Moore Measure 3 (Late Stage) Chart Review

2021-12-07

Here is a hypothetical case to illustrate unclear parts of the chart
review process.




## Early phase of diagnostic process

- Patient never had low dose chest CT for screening for lung cancer,
  even though he qualified. Therefore, **yes to MOD** in general.

- Presents with cough March 1. This is date of "cancer signal
  recorded" (**date_signal**).

- PCP orders CXR same day, March 1.

- CXR completed same day, March 1. Some abnormal but nonspecific
  findings.

- PCP orders f/u CT March 3 (**date_initiate**, but see below). No MOD
  for this interval because < 7 days.

- CT is completed April 3 (**date_complete**). Likewise no MOD because
  30 days < 60 days.




## Late phase of diagnostic process

- Evidence of MD reviewing CT result April 7.

- MD orders PET, per CT recommendations, on April 8.

- PET is performed August 8.

- Result review (of PET) documented on Aug 10

- Consult for interventional radiology (or pulmonology or thoracic
  surg or "chest medicine") ordered on Aug 12.

- Biopsy complete, by whatever means, or patient sometimes diagnosed
without biopsy, and diagnosis is *formally* made (**date_dx**). Often
pre-populated by registry. **date_complete** to **date_dx** measures
the "late stage" process (from CT to diagnosis in this example).
**date_signal** to **date_dx** measures the whole diagnostic process.

Chart review ends (hard stop) at date of diagnosis, **date_dx**. No
need to evaluate delays in certain parts of cancer treatment, imaging
studies obtained to evaluate response to treatment, etc.




## Concerns, comments, questions

1. Should the date of CXR ordering be the date of "cancer-related
diagnostic evaluation" (**date_initiate**)? Because CXR is somewhat
nonspecific. Or should the date of CT ordering be this date, because
it is more specific than CXR?

2. The events in the "late phase" are somewhat undefined. Is this
okay? One primary example but not the only one: How many days are
acceptable from PET ordering to PET performed? Do we need to establish
a specific number of days for this interval (reference value for PET
ordering)? In this case, should the 4 months it took to perform PET
the reviewer check "yes to MOD?"

3. If the late phase obviously proceeds promptly (say 30 days) is it
necessary to do detailed chart review of this phase?