Measure Intake Form

Thank you for your interest in The American Society of Clinical Oncology’s measure work. If you would like to propose a potential topic for measure development, please fill out the form below. Please note that every submission will be reviewed by ASCO measurement staff prior to being presented to the Measures Steering Group. It is not guaranteed that your submission will become a priority for development, but we thank you for taking the time to submit a topic.

Name*

Affiliation*

Email Address*

Proposed Measure Topic*

Please provide specific details of the proposed measure such as disease type, and the intent of the measure.

If possible, please provide recommendations of defining the following measure components:

- Initial Populations - Numerator - Denominator - Denominator Exclusions

Is there a gap in care or variation in performance across this proposed topic?

If yes, please explain.

Are there other similar measures that have already been developed?

If yes, include which organization(s) have developed them

Evidence that supports the measure

Please tell us about any guidelines, studies, or other evidence sources that provide support for the measure.

File Attachments (optional)

Please provide additional documentation relevant to the measure request

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Date Submitted

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